Provider Demographics
NPI:1326316837
Name:MARSH, CRYSTAL MARY (PT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MARY
Last Name:MARSH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:MARY
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:34 PEARLY LN
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-1736
Mailing Address - Country:US
Mailing Address - Phone:978-632-1230
Mailing Address - Fax:978-632-4513
Practice Address - Street 1:34 PEARLY LN
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-1736
Practice Address - Country:US
Practice Address - Phone:978-632-1230
Practice Address - Fax:978-632-4513
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist