Provider Demographics
NPI:1548005937
Name:BENTHAL, KRISTINA MARIE (NCLMBT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:BENTHAL
Suffix:
Gender:F
Credentials:NCLMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 HAZELWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3763
Mailing Address - Country:US
Mailing Address - Phone:828-748-4079
Mailing Address - Fax:
Practice Address - Street 1:107 MERRIMON AVE STE 324
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2357
Practice Address - Country:US
Practice Address - Phone:828-610-8558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15754225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist