Provider Demographics
NPI:1124038039
Name:THOMAS, CRYSTAL D (DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATLEY HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11798-1419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14 WALL ST
Practice Address - Street 2:MAIN FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-2101
Practice Address - Country:US
Practice Address - Phone:212-587-8606
Practice Address - Fax:212-587-9024
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027131-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ21F7QA561Medicare PIN