Provider Demographics
NPI:1134596109
Name:JOYCE, KRYSTAL ANN (DPT)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:ANN
Last Name:JOYCE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:ANN
Other - Last Name:PALCZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 82
Mailing Address - Street 2:
Mailing Address - City:GERALDINE
Mailing Address - State:MT
Mailing Address - Zip Code:59446-0082
Mailing Address - Country:US
Mailing Address - Phone:406-459-2404
Mailing Address - Fax:
Practice Address - Street 1:1714 FRONT ST.
Practice Address - Street 2:
Practice Address - City:FORT BENTON
Practice Address - State:MT
Practice Address - Zip Code:59442
Practice Address - Country:US
Practice Address - Phone:406-622-3684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP PT LIC 5059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTPTP PT LIC 5950OtherMT PT LICENSE #