Healthcare Provider Details

I. General information

NPI: 1831485200
Provider Name (Legal Business Name): CRYSTAL LYNN MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 HOLLYWOOD DR
JEFFERSON HILLS PA
15025-4004
US

IV. Provider business mailing address

3000 NORTHWOODS PKWY SUITE 105
NORCROSS GA
30071-4708
US

V. Phone/Fax

Practice location:
  • Phone: 412-780-0430
  • Fax:
Mailing address:
  • Phone: 866-518-1750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT021303
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: