Provider Demographics
NPI:1902860430
Name:CRYTZER, JACQUELINE ANNE (ATC)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ANNE
Last Name:CRYTZER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-2723
Mailing Address - Country:US
Mailing Address - Phone:631-742-3865
Mailing Address - Fax:
Practice Address - Street 1:271 JEFFERSON DR
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-2723
Practice Address - Country:US
Practice Address - Phone:631-742-3865
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer