MEDICARE: KRYOKRYSTA

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1588490155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRYOKRYSTA

Provider Business Mailing Address
First Line	:	1980 NW 94TH ST STE E
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-6935
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1980 NW 94TH ST STE E
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-6935
Country	:	US
Telephone Number	:	712-250-0990
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRYSTA METZ BRYARS
Credential	:	DPT
Telephone Number	:	712-250-0990

Provider Enumeration Date	:	09/11/2024
Last Update Date	:	09/11/2024

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Directions to “KRYOKRYSTA ” Practice Location

Language	Start Address	Practice Location

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