Provider Demographics
NPI:1477035624
Name:RAYBON, KRYSTAL LYNN
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:LYNN
Last Name:RAYBON
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 1:218 CONNELL FERRY RD
Mailing Address - Street 2:
Mailing Address - City:JOAQUIN
Mailing Address - State:TX
Mailing Address - Zip Code:75954-2402
Mailing Address - Country:US
Mailing Address - Phone:903-692-2066
Mailing Address - Fax:
Practice Address - Street 1:333 FM 95
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:TX
Practice Address - Zip Code:75946
Practice Address - Country:US
Practice Address - Phone:936-347-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2101387225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant