Provider Demographics
NPI:1518391341
Name:WHITMAN, CRYSTAL NICOLE-MARIE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:NICOLE-MARIE
Last Name:WHITMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5411 W CINNABAR AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-2219
Mailing Address - Country:US
Mailing Address - Phone:602-367-9311
Mailing Address - Fax:
Practice Address - Street 1:5411 W. CINNABAR AVE.
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302
Practice Address - Country:US
Practice Address - Phone:602-367-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10283APTA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant