Healthcare Provider Details

I. General information

NPI: 1538091418
Provider Name (Legal Business Name): KRYSTAL VICTORIA SMITH LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3944 FLORIDA BLVD STE 103
PALM BEACH GARDENS FL
33410-2271
US

IV. Provider business mailing address

57 E 27TH ST APT 1
RIVIERA BEACH FL
33404-4569
US

V. Phone/Fax

Practice location:
  • Phone: 561-782-5868
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA90636
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: