Provider Demographics
NPI:1184829111
Name:CRICK, DESTINY SHEA (PTA)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:SHEA
Last Name:CRICK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2827 PARADISE RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-5537
Mailing Address - Country:US
Mailing Address - Phone:270-977-2323
Mailing Address - Fax:
Practice Address - Street 1:2827 PARADISE RD
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-5537
Practice Address - Country:US
Practice Address - Phone:270-977-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01971225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant