MEDICARE: MS. CRYSTAL LENE MURPHY PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2001024020	MO

General Provider Information

NPI Number	:	1033373642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CRYSTAL LENE MURPHY PTA

Provider Business Mailing Address
First Line	:	6335 LENA AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-3547
Country	:	US
Telephone Number	:	314-629-4313
Fax Number	:

Provider Business Practice Location Address
First Line	:	11960 WESTLINE INDUSTRIAL DR STE 201
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3209
Country	:	US
Telephone Number	:	314-819-0480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2008
Last Update Date	:	07/12/2008

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