Healthcare Provider Details

I. General information

NPI: 1033726260
Provider Name (Legal Business Name): CRISTINA CRAWFORD LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/01/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 GREAT HOLLOW
TRURO MA
02666-1035
US

IV. Provider business mailing address

PO BOX 1035
TRURO MA
02666-1035
US

V. Phone/Fax

Practice location:
  • Phone: 978-992-7498
  • Fax:
Mailing address:
  • Phone: 774-538-9374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number15655
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: