Provider Demographics
NPI:1619287349
Name:RAINEY, CRYSTAL LYNN
Entity Type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:LYNN
Last Name:RAINEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17304 PRESTON ROAD
Mailing Address - Street 2:SUITE 530
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252
Mailing Address - Country:US
Mailing Address - Phone:972-733-6860
Mailing Address - Fax:972-733-6861
Practice Address - Street 1:17304 PRESTON ROAD
Practice Address - Street 2:SUITE 530
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252
Practice Address - Country:US
Practice Address - Phone:972-733-6860
Practice Address - Fax:972-733-6861
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21198225200000X
TX2069628225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant