Provider Demographics
NPI:1376872267
Name:SHIRK, CRYSTAL (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:SHIRK
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 N CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-2909
Mailing Address - Country:US
Mailing Address - Phone:828-669-7188
Mailing Address - Fax:
Practice Address - Street 1:707 N CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-2909
Practice Address - Country:US
Practice Address - Phone:828-989-8192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer