Healthcare Provider Details

I. General information

NPI: 1770417339
Provider Name (Legal Business Name): CRYSTAL LEIGH HARROD LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6463 LOUISVILLE RD
BOWLING GREEN KY
42101-8009
US

IV. Provider business mailing address

6813 GLEN LILY RD
BOWLING GREEN KY
42101-7803
US

V. Phone/Fax

Practice location:
  • Phone: 364-203-8190
  • Fax:
Mailing address:
  • Phone: 364-203-8190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number293838
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number15024
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: