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General NPI Number Information
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NPI Number | 1669607420
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Entity Type | Individual
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Provider Name | CRYSTAL MARIE FORREST LMBT
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Gender | Female
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Dates
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Enumeration Date | 05/22/2009
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Last Update Date | 05/22/2009
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Provider Practice Location Address
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Address Line | 46527 RANDALLS CHURCH RD
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City | NORWOOD
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State | NC
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Zip | 28128
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Country | US
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Telephone | 704-984-2553
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Fax | 704-474-3568
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Provider Business Mailing Address
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Address Line | 46527 RANDALLS CHURCH RD
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City | NORWOOD
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State | NC
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Zip | 28128
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Country | US
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Telephone | 704-984-2553
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Fax | 704-474-3568
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | #1634
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | #286332-00
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License Number State |
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