Provider Demographics
NPI:1568125979
Name:WOODS, CRYSTAL GALE (CPT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:GALE
Last Name:WOODS
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 BLUESTEM CIR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5901
Mailing Address - Country:US
Mailing Address - Phone:979-200-8031
Mailing Address - Fax:
Practice Address - Street 1:3321 BLUESTEM CIR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5901
Practice Address - Country:US
Practice Address - Phone:979-200-8031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5G6A5H7374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician