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General NPI Number Information
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NPI Number | 1881520302
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Entity Type | Organization
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Legal Business Name | CRYSTALLIZED 2.0 LLC
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Dates
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Enumeration Date | 06/22/2026
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Last Update Date | 06/22/2026
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Provider Practice Location Address
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Address Line | 903 RATHLIN LN
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City | BEAR
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State | DE
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Zip | 19701-1987
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Country | US
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Telephone | 646-477-9493
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 349
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City | BEAR
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State | DE
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Zip | 19701-0349
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. CRYSTAL THOMAS-MCGEE
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Credential | PT, DPT, MBA
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Telephone | 631-766-4236
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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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