Provider Demographics
NPI:1821386533
Name:CARTER, CRYSTAL LEE (PTA, LMT)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:LEE
Last Name:CARTER
Suffix:
Gender:F
Credentials:PTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 SMOKY RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20639-8611
Mailing Address - Country:US
Mailing Address - Phone:240-481-9765
Mailing Address - Fax:
Practice Address - Street 1:2245 SMOKY RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTOWN
Practice Address - State:MD
Practice Address - Zip Code:20639-8611
Practice Address - Country:US
Practice Address - Phone:240-481-9765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2374225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant