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General NPI Number Information
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NPI Number | 1942966288
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Entity Type | Individual
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Provider Name | CRYSTAL PATRICE GIOCONDO PTA
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Gender | Female
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 4951 CLINE HOLLOW RD
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City | MURRYSVILLE
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State | PA
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Zip | 15668-1580
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Country | US
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Telephone | 724-733-9494
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Fax |
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Provider Business Mailing Address
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Address Line | 6371 KEMERER HOLLOW RD
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City | EXPORT
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State | PA
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Zip | 15632-1553
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Country | US
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Telephone | 843-340-3440
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1676
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | TEI005457
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License Number State | PA
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