Provider Demographics
NPI:1255088696
Name:RICHEY, CRYSTAL (ATC, LMT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:RICHEY
Suffix:
Gender:F
Credentials:ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 CLEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-7615
Mailing Address - Country:US
Mailing Address - Phone:816-695-5478
Mailing Address - Fax:
Practice Address - Street 1:1804 CLEAR CREEK DR
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-7615
Practice Address - Country:US
Practice Address - Phone:816-695-5478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-06
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220006132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer