Provider Demographics
NPI:1922769736
Name:LIKE, CRYSTAL (PTA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:LIKE
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 1:15 COUNTY ROAD 6550
Mailing Address - Street 2:
Mailing Address - City:COLT
Mailing Address - State:AR
Mailing Address - Zip Code:72326-9451
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1116 N NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BRINKLEY
Practice Address - State:AR
Practice Address - Zip Code:72021-2126
Practice Address - Country:US
Practice Address - Phone:870-734-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA4276225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant