Provider Demographics
NPI:1144275504
Name:TOLL, CRYSTAL M (PT)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:M
Last Name:TOLL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-332-7475
Mailing Address - Fax:414-332-7494
Practice Address - Street 1:4655 N PORT WASHINGTON RD STE 350
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1004
Practice Address - Country:US
Practice Address - Phone:414-332-7475
Practice Address - Fax:414-332-7494
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9995-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36149700Medicaid