Crystal Rose Shutt, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

P160321635 Issued in WA

Practice address

400 E 33Rd St
Vancouver, WA 98663-2238

Phone

(360) 696-2561

NPI assigned

Jan 3, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1388707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388707200000",
    "number": "1306267737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 W EVERGREEN BLVD #107",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986603002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E 33RD ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986632238",
            "telephone_number": "360-696-2561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUTT",
        "first_name": "CRYSTAL",
        "middle_name": "ROSE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-03",
        "last_updated": "2014-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WA",
            "license": "P160321635",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "OR",
            "license": "08925",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth A Shultz, EDD
• Susan K. Shultz, D.C., L.AC.
• Taylor Michele Shultz
• Yelena Shurov, RUSSIAN INTERPRETER
• Allison Karan Shuster, PA-C
• Gordon Shyu, DO
• Celine Pearl So Si, MD
• Justin Lyle Sichula, MD
• Faisal Amin Siddiqui, MD, PHD
• Subeeh A Siddiqui, MD

• Physical Therapy Assistant in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Physical Therapy Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.