Provider Demographics
NPI:1649897646
Name:PLACE, KRYSTAL (DPT)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:PLACE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 MARKET ST STE A
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2714
Mailing Address - Country:US
Mailing Address - Phone:423-648-4490
Mailing Address - Fax:423-648-4491
Practice Address - Street 1:1201 MARKET ST STE A
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2714
Practice Address - Country:US
Practice Address - Phone:423-648-4490
Practice Address - Fax:423-648-4491
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist