Provider Demographics
NPI:1891046868
Name:GREER, CHRYSTAL SUSAN (PTA)
Entity Type:Individual
Prefix:MISS
First Name:CHRYSTAL
Middle Name:SUSAN
Last Name:GREER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 GALAXY DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-1687
Mailing Address - Country:US
Mailing Address - Phone:812-475-2822
Mailing Address - Fax:
Practice Address - Street 1:3001 GALAXY DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-1687
Practice Address - Country:US
Practice Address - Phone:812-475-2822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004190A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant