Individual
CRYSTAL RENAY WIEDL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
222 FULCHER ST, HILLSVILLE, VA 24343-1633
(276) 728-2486
Mailing address
6085 STONEY FORK RD, WYTHEVILLE, VA 24382-5803
(276) 620-0961
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306605452
VA
Other
Enumeration date
09/20/2020
Last updated
09/20/2020
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