Individual
MICKENZIE JO CRISWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
303 N HURSTBOURNE PKWY, SUITE 200, LOUISVILLE, KY 40222-5185
(502) 412-5847
Mailing address
202 N MADISON ST, REPUBLIC, OH 44867-9790
(419) 618-0295
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
08834
OH
Other
Enumeration date
02/15/2013
Last updated
02/15/2013
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