Provider Demographics
NPI:1811703457
Name:CRYSTAL TRAINING INSTITUTE, LLC
Entity type:Organization
Organization Name:CRYSTAL TRAINING INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-298-2104
Mailing Address - Street 1:880 S VIEW DR STE 15132
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-8205
Mailing Address - Country:US
Mailing Address - Phone:715-432-4921
Mailing Address - Fax:
Practice Address - Street 1:880 S VIEW DR STE 15132
Practice Address - Street 2:
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455-8205
Practice Address - Country:US
Practice Address - Phone:715-298-2104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy