Provider Demographics
NPI:1689157810
Name:STAMPS, CRYSTAL VESS
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:VESS
Last Name:STAMPS
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 1:11930 BRIGHTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-5467
Mailing Address - Country:US
Mailing Address - Phone:936-827-8960
Mailing Address - Fax:
Practice Address - Street 1:11930 BRIGHTWOOD DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5467
Practice Address - Country:US
Practice Address - Phone:936-827-8960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11775132251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics