Provider Demographics
NPI:1639424138
Name:KRITIKOS, CRYSTAL LYNN (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:LYNN
Last Name:KRITIKOS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 ATLANTA RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2707
Mailing Address - Country:US
Mailing Address - Phone:678-947-0952
Mailing Address - Fax:678-947-3579
Practice Address - Street 1:815 ATLANTA RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2707
Practice Address - Country:US
Practice Address - Phone:678-947-0952
Practice Address - Fax:678-947-3579
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist