Provider Demographics
NPI:1336468750
Name:DAVIS, CHRYSTAL JO
Entity Type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:JO
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:FARRELL
Mailing Address - State:PA
Mailing Address - Zip Code:16121-1357
Mailing Address - Country:US
Mailing Address - Phone:724-983-7176
Mailing Address - Fax:
Practice Address - Street 1:110 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-1726
Practice Address - Country:US
Practice Address - Phone:724-589-6287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist