Provider Demographics
NPI:1144549098
Name:FLAKE, CHRYSTEL CLOTILDA (PT,MS)
Entity type:Individual
Prefix:
First Name:CHRYSTEL
Middle Name:CLOTILDA
Last Name:FLAKE
Suffix:
Gender:F
Credentials:PT,MS
Other - Prefix:
Other - First Name:CHRYSTEL
Other - Middle Name:CLOTILDA
Other - Last Name:DSOUZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9518 PAINTER DR
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-7118
Mailing Address - Country:US
Mailing Address - Phone:479-769-5188
Mailing Address - Fax:
Practice Address - Street 1:9518 PAINTER DR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-7118
Practice Address - Country:US
Practice Address - Phone:479-769-5188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT-3441-L225100000X
TX1184860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist