Provider Demographics
NPI:1104994425
Name:SMITH, KRYSTAL (ATC)
Entity type:Individual
Prefix:MISS
First Name:KRYSTAL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 PERSIMMON CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8620
Mailing Address - Country:US
Mailing Address - Phone:714-393-9115
Mailing Address - Fax:
Practice Address - Street 1:1000 SPRING GARDEN ST.
Practice Address - Street 2:136 HHP BUILDING, UNCG ATHLETICS
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27402-6168
Practice Address - Country:US
Practice Address - Phone:336-334-5925
Practice Address - Fax:334-256-0407
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer