Provider Demographics
NPI:1205007705
Name:NESTLEHUTT, KRYSTAL SMITH (MPT)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:SMITH
Last Name:NESTLEHUTT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:DAWN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1755 HIGHWAY 34 E STE 1300
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-3186
Mailing Address - Country:US
Mailing Address - Phone:770-254-7850
Mailing Address - Fax:770-254-1394
Practice Address - Street 1:1755 HIGHWAY 34 E STE 1300
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-3186
Practice Address - Country:US
Practice Address - Phone:770-254-7850
Practice Address - Fax:770-254-1394
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009035225100000X
GAPT0090362251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist