Individual
CRYSTAL DRAGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3165 SACRAMENTO ST, PLACERVILLE, CA 95667-5530
(707) 365-8864
Mailing address
3165 SACRAMENTO ST, PLACERVILLE, CA 95667-5530
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
51025
CA
Other
Enumeration date
01/05/2022
Last updated
01/05/2022
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