Provider Demographics
NPI:1033883319
Name:DANIEL, KRYSTAL (PTA, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:DANIEL
Suffix:
Gender:F
Credentials:PTA, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 LINDSEY LN
Mailing Address - Street 2:
Mailing Address - City:SIMMS
Mailing Address - State:TX
Mailing Address - Zip Code:75574-4717
Mailing Address - Country:US
Mailing Address - Phone:903-908-2511
Mailing Address - Fax:
Practice Address - Street 1:222 LINDSEY LN
Practice Address - Street 2:
Practice Address - City:SIMMS
Practice Address - State:TX
Practice Address - Zip Code:75574-4717
Practice Address - Country:US
Practice Address - Phone:903-908-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant