Provider Demographics
NPI:1588490155
Name:KRYOKRYSTA
Entity type:Organization
Organization Name:KRYOKRYSTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTA
Authorized Official - Middle Name:METZ
Authorized Official - Last Name:BRYARS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:712-250-0990
Mailing Address - Street 1:1980 NW 94TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-6935
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1980 NW 94TH ST STE E
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-6935
Practice Address - Country:US
Practice Address - Phone:712-250-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy