Individual
CRYSTAL KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
5949 W RAYMOND ST, INDIANAPOLIS, IN 46241-4348
(317) 390-5599
(317) 486-2189
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05008563A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000372346
ANTHEM ID
IN
05
—
200526800
—
IN
Enumeration date
03/02/2006
Last updated
08/14/2016
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