Healthcare Provider Details

I. General information

NPI: 1346860343
Provider Name (Legal Business Name): CRYSTAL D HELMEID LMBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2427 SMITHTOWN RD
EAST BEND NC
27018-8239
US

IV. Provider business mailing address

2637 LIME ROCK RD
BOONVILLE NC
27011-8133
US

V. Phone/Fax

Practice location:
  • Phone: 608-449-3424
  • Fax:
Mailing address:
  • Phone: 608-449-3424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14918
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: