Provider Demographics
NPI:1861732596
Name:CRILLY, KAREN L (PT, MAPT, DPT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:CRILLY
Suffix:
Gender:F
Credentials:PT, MAPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17111 KENTON DR STE 206B
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5650
Mailing Address - Country:US
Mailing Address - Phone:704-892-8074
Mailing Address - Fax:704-892-8075
Practice Address - Street 1:17111 KENTON DR STE 206B
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5650
Practice Address - Country:US
Practice Address - Phone:704-892-8074
Practice Address - Fax:704-892-8075
Is Sole Proprietor?:No
Enumeration Date:2013-02-16
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP114952251P0200X, 225100000X, 2251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology