Provider Demographics
NPI:1548380652
Name:MAYFIELD, CRYSTAL L (PT)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:L
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22278 NORTHWESTERN PIKE
Mailing Address - Street 2:
Mailing Address - City:ROMNY
Mailing Address - State:WV
Mailing Address - Zip Code:26757
Mailing Address - Country:US
Mailing Address - Phone:304-822-6024
Mailing Address - Fax:304-822-7989
Practice Address - Street 1:22278 NORTHWESTERN PIKE
Practice Address - Street 2:
Practice Address - City:ROMNY
Practice Address - State:WV
Practice Address - Zip Code:26757
Practice Address - Country:US
Practice Address - Phone:304-822-6024
Practice Address - Fax:304-822-7989
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22849225100000X
WV1308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist