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General NPI Number Information
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NPI Number | 1811703457
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Entity Type | Organization
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Legal Business Name | CRYSTAL TRAINING INSTITUTE, LLC
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 880 S VIEW DR STE 15132
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City | MOSINEE
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State | WI
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Zip | 54455-8205
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Country | US
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Telephone | 715-298-2104
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Fax |
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Provider Business Mailing Address
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Address Line | 880 S VIEW DR STE 15132
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City | MOSINEE
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State | WI
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Zip | 54455-8205
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Country | US
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Telephone | 715-432-4921
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | SAMUEL ZIMMERMAN
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Credential |
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Telephone | 715-298-2104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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