MEDICARE: CRYSTAL ANNE CRITES MPT

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	225100000X	Physical Therapist	PT 27487	CA
2	225100000X	Physical Therapist	5583	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0PT274870	OTHER	CA	BLUE SHIELD
3	72157585392277A008	OTHER	CA	TRICARE

General Provider Information

NPI Number	:	1144367301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL ANNE CRITES MPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-206-4158
Fax Number	:	717-773-4654

Provider Business Practice Location Address
First Line	:	2560 E KENOSHA ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74014-6712
Country	:	US
Telephone Number	:	918-994-7864
Fax Number	:

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/26/2022

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Directions to “ CRYSTAL ANNE CRITES MPT” Practice Location

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