Provider Demographics
NPI:1346610383
Name:GAINES, KRYSTAL LYN
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:LYN
Last Name:GAINES
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 1:108 CHESAPEAKE HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-4732
Mailing Address - Country:US
Mailing Address - Phone:615-238-4369
Mailing Address - Fax:
Practice Address - Street 1:108 CHESAPEAKE HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-4732
Practice Address - Country:US
Practice Address - Phone:615-238-4369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6120225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant