Provider Demographics
NPI:1972145886
Name:LONG, CRYSTOPHER J (PT)
Entity Type:Individual
Prefix:
First Name:CRYSTOPHER
Middle Name:J
Last Name:LONG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 E IRON AVE STE 224
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3433
Mailing Address - Country:US
Mailing Address - Phone:785-407-0180
Mailing Address - Fax:
Practice Address - Street 1:PARKWAY POST ACUTE RECOVERY CENTER
Practice Address - Street 2:6312 N PORTLAND
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-272-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist