Provider Demographics
NPI:1023209970
Name:CALTON, CRYSTAL R (PT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:R
Last Name:CALTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 TRAIL BOSS
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-4667
Mailing Address - Country:US
Mailing Address - Phone:210-269-6038
Mailing Address - Fax:
Practice Address - Street 1:7909 PAT BOOKER RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-2602
Practice Address - Country:US
Practice Address - Phone:210-590-7412
Practice Address - Fax:210-590-2343
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1174591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist