Provider Demographics
NPI:1831805381
Name:CHRISTENSEN, KRYSTAL (LMT, MLD-C)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:LMT, MLD-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10408 S 1055 W STE 201
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-1511
Mailing Address - Country:US
Mailing Address - Phone:385-464-9550
Mailing Address - Fax:
Practice Address - Street 1:10408 S 1055 W STE 201
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-1511
Practice Address - Country:US
Practice Address - Phone:385-464-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11297494-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist