Provider Demographics
NPI:1942966288
Name:GIOCONDO, CRYSTAL PATRICE (PTA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:PATRICE
Last Name:GIOCONDO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:TART
Other - Last Name:STEINBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:6371 KEMERER HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:EXPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15632-1553
Mailing Address - Country:US
Mailing Address - Phone:843-340-3440
Mailing Address - Fax:
Practice Address - Street 1:4951 CLINE HOLLOW RD
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1580
Practice Address - Country:US
Practice Address - Phone:724-733-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1676225200000X
PATEI005457225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant