Provider Demographics
NPI:1952781122
Name:KRIMM, CRYSTAL GAIL (MPT)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:GAIL
Last Name:KRIMM
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MRS
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:BAISDEN-BELLOMY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:RT. 1 BOX 1478
Mailing Address - Street 2:
Mailing Address - City:WILSONDALE
Mailing Address - State:WV
Mailing Address - Zip Code:25699
Mailing Address - Country:US
Mailing Address - Phone:304-393-4565
Mailing Address - Fax:
Practice Address - Street 1:47454 ROUTE 52
Practice Address - Street 2:
Practice Address - City:KERMIT
Practice Address - State:WV
Practice Address - Zip Code:25674
Practice Address - Country:US
Practice Address - Phone:304-393-4072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT002450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist