Provider Demographics
NPI:1073701793
Name:SIMPSON, CRYSTAL GUNN (PT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:GUNN
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:CHAUNTEL
Other - Last Name:GUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:12 MEDSTAR BLVD STE 325
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-1817
Mailing Address - Country:US
Mailing Address - Phone:410-877-8078
Mailing Address - Fax:410-877-8079
Practice Address - Street 1:12 MEDSTAR BLVD STE 325
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015
Practice Address - Country:US
Practice Address - Phone:410-877-8078
Practice Address - Fax:410-877-8079
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT8071225100000X
MD26951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist