Provider Demographics
NPI:1033855606
Name:CATES, CRYSTAL ARIEL (LMT, MTI)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ARIEL
Last Name:CATES
Suffix:
Gender:F
Credentials:LMT, MTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 536122
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75053-6122
Mailing Address - Country:US
Mailing Address - Phone:469-990-1380
Mailing Address - Fax:
Practice Address - Street 1:2100 N HWY 360 STE 1204
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1033
Practice Address - Country:US
Practice Address - Phone:469-990-1380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT132597225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty