Provider Demographics
NPI:1558545913
Name:GOLDEN, CRYSTAL GAYLE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:GAYLE
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MR
Other - First Name:CRYSTAL
Other - Middle Name:GAYLE
Other - Last Name:FIELDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5501 N PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2074
Mailing Address - Country:US
Mailing Address - Phone:405-640-6000
Mailing Address - Fax:
Practice Address - Street 1:5501 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2074
Practice Address - Country:US
Practice Address - Phone:405-640-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1317225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant