Provider Demographics
NPI:1003224072
Name:MCMAHON, CRYSTAL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 W CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6015
Mailing Address - Country:US
Mailing Address - Phone:559-713-6806
Mailing Address - Fax:559-713-6809
Practice Address - Street 1:606 N MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-9206
Practice Address - Country:US
Practice Address - Phone:559-321-8162
Practice Address - Fax:559-472-3559
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1245138225100000X
TN10057225100000X
CA41813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist