MEDICARE: CRYSTAL DELGADO MCCRAW LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA81157	FL

General Provider Information

NPI Number	:	1104437821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL DELGADO MCCRAW LMT

Provider Business Mailing Address
First Line	:	8339 WEYBRIDGE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-6198
Country	:	US
Telephone Number	:	904-403-9940
Fax Number	:

Provider Business Practice Location Address
First Line	:	869 STOCKTON ST STE 8
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3590
Country	:	US
Telephone Number	:	904-395-4288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2020
Last Update Date	:	08/14/2020

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