| Doctor Name: | KRYSTAL NICOLE MEDIANO |
| NPI Number: | 1508013913 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 3106388 |
| Business Practice Address: | 2525 N Grandview Ave Suite 400 Odessa, TX - 797611600 |
| Business Phone Number: | 4325504700 |
| Business Fax Number: | 4325504715 |
| Mailing Address: | 2525 N Grandview Ave, Suite 400 ODESSA |
| State: | TX |
| Postal Code: | 797611600 |
| Phone Number: | 4325504700 |
| Fax Number: | 4325504715 |
| NPI Enumeration Date: | 08/27/2008 |
| NPI Last Update Date: | 04/14/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 3106388 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |