Healthcare Provider Details

I. General information

NPI: 1811802101
Provider Name (Legal Business Name): KRYSTIN OSBORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LEADER DR
WILLIAMSPORT PA
17701-1943
US

IV. Provider business mailing address

103 TIFFANY DR
WILLIAMSPORT PA
17701-9622
US

V. Phone/Fax

Practice location:
  • Phone: 570-323-8627
  • Fax:
Mailing address:
  • Phone: 570-666-7936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI007006
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: