Provider Demographics
NPI:1003987504
Name:DISNEY, KRYSTAL D (PTA)
Entity type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:D
Last Name:DISNEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:KRYSTAL
Other - Middle Name:D
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:RR 1 BOX 467
Mailing Address - Street 2:
Mailing Address - City:ROARING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:16673-9801
Mailing Address - Country:US
Mailing Address - Phone:814-793-3434
Mailing Address - Fax:
Practice Address - Street 1:1798 OLD ROUTE 220 N
Practice Address - Street 2:SUITE 103
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-8341
Practice Address - Country:US
Practice Address - Phone:814-696-3400
Practice Address - Fax:814-696-3402
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE006568225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant