Provider Demographics
NPI:1063635803
Name:FERRIS, CRYSTAL C (DPT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:C
Last Name:FERRIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 SOUTH ORCHARD LANE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-1625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 NORTHPARK BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-6119
Practice Address - Country:US
Practice Address - Phone:985-871-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07337R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist