Provider Demographics
NPI:1942193032
Name:CRUTCHFIELD, KRISTA (PTA)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:CRUTCHFIELD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2171 W SHOSHONE AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-5237
Mailing Address - Country:US
Mailing Address - Phone:253-327-4068
Mailing Address - Fax:
Practice Address - Street 1:1020 N HICKORY AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8006
Practice Address - Country:US
Practice Address - Phone:208-314-4988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7271961225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant