Provider Demographics
NPI:1598907339
Name:SUMNER, CRYSTAL LEIGH (PT)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LEIGH
Last Name:SUMNER
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 1:1267 OAK GROVE RD SW
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701
Mailing Address - Country:US
Mailing Address - Phone:770-324-8560
Mailing Address - Fax:706-612-1286
Practice Address - Street 1:20 POINTE NORTH DR UNIT 109
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-7955
Practice Address - Country:US
Practice Address - Phone:770-324-8560
Practice Address - Fax:470-588-8934
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0083072251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics