Basic Information
| Provider Information | |||||||||
| NPI: | 1639424138 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRITIKOS | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 ATLANTA RD | ||||||||
| Address2: | |||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300402707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789470952 | ||||||||
| FaxNumber: | 6789473579 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 ATLANTA RD | ||||||||
| Address2: | |||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300402707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789470952 | ||||||||
| FaxNumber: | 6789473579 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2012 | ||||||||
| LastUpdateDate: | 02/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT010681 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.