Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 7398213-8019 | UT |
NPI | 1003114836 |
---|---|
Provider Name | Ms. Krista L Crown |
First Address | Sandy, UT 84094-3763 |
Second Address | Sandy, UT 84094-3763 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2011 |
Last Update Date | 02/03/2011 |