Provider Demographics
NPI:1801116827
Name:GIPSON, CRYSTAL LYNN (DPT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LYNN
Last Name:GIPSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:L
Other - Last Name:CONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:113 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:KS
Mailing Address - Zip Code:66535-9621
Mailing Address - Country:US
Mailing Address - Phone:402-708-5285
Mailing Address - Fax:
Practice Address - Street 1:1823 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3381
Practice Address - Country:US
Practice Address - Phone:785-587-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-02677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist