Individual
CRYSTAL M BOURCIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
11143 PARKVIEW PLAZA DR STE 100, FORT WAYNE, IN 46845-1728
(260) 266-7400
(260) 266-7439
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
(260) 432-4700
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05009304A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100257920
GROUP MEDICAID
IN
01
—
156546
GROUP MEDICARE
IN
05
—
200877990A
—
IN
Enumeration date
08/05/2007
Last updated
12/17/2020
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