| Provider / Organization | NPI | Date Certified |
|---|---|---|
| CRYSTAL RENAY WIEDL | 1144836651 | 2020-09-20 |
Crystal Renay Wiedl is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1144836651. Registration indicates Crystal Renay Wiedl is a provider of services with a specialization in Respiratory, Developmental, Rehabilitative and Restorative Service Providers, Physical Therapy Assistant (Physical Therapy Assistant, ) (Speech/Occupational/Physical Therapy/Chiropractor, ) (Physical Therapy Assistant, Respiratory, Developmental, Rehabilitative and Restorative Service Providers)
| Entity Type | Individual |
| Provider Name | Crystal Renay Wiedl |
| Practice Office Address | 222 FULCHER ST HILLSVILLE, VA US |
| Practice Office Telephone | 2767282486 |
| Mailing Address | 6085 STONEY FORK RD WYTHEVILLE, VA 243825803 US |
| Business Telephone | 2766200961 |
| Code | Practice | License No State |
|---|---|---|
| 225200000X PRIMARY | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Physical Therapy Assistant Physical Therapy Assistant Speech/Occupational/Physical Therapy/Chiropractor Physical Therapy Assistant Respiratory, Developmental, Rehabilitative and Restorative Service Providers | 2306605452
VA |