Crystal Larae Wilson

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA28027 Issued in FL

Practice address

1110 Hospital Rd BLDG B
Fort Walton Beach, FL 32547-6742

Phone

(850) 863-8129

NPI assigned

Feb 12, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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": "1613088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613088000000",
    "number": "1316530157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2062 ORTEGA ST",
            "city": "NAVARRE",
            "state": "FL",
            "postal_code": "325662178",
            "telephone_number": "386-984-2350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 HOSPITAL RD BLDG B",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476742",
            "telephone_number": "850-863-8129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CRYSTAL",
        "middle_name": "LARAE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-12",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA28027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reddoch Evans Williams, MD
• Scot T Williams, PA
• William Williamson
• Barbara E Wilson
• Cali Wilson, PA-C
• Heather Wilson, RBT
• Matthew J Wilson, LMT
• Reemeka Lasha Wilson, MASTER OF SCIENCE
• Beverly Wilusz, LMHC
• Abbey Winblad, PT

• Physical Therapy Assistant in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2021; 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.