MEDICARE: KRYSTLE L CAMERON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA96255	FL

General Provider Information

NPI Number	:	1558007708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTLE L CAMERON

Provider Business Mailing Address
First Line	:	4724 NW 43RD ST
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-4634
Country	:	US
Telephone Number	:	754-303-1888
Fax Number	:

Provider Business Practice Location Address
First Line	:	4724 NW 43RD ST
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-4634
Country	:	US
Telephone Number	:	754-303-1888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2022
Last Update Date	:	05/10/2022

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Directions to “ KRYSTLE L CAMERON ” Practice Location

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