Provider Demographics
NPI:1073155867
Name:BARRON, KRYSTA
Entity Type:Individual
Prefix:
First Name:KRYSTA
Middle Name:
Last Name:BARRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 1/2 GILES AVE
Mailing Address - Street 2:
Mailing Address - City:BLISSFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49228-1225
Mailing Address - Country:US
Mailing Address - Phone:517-215-1466
Mailing Address - Fax:
Practice Address - Street 1:414 1/2 GILES AVE
Practice Address - Street 2:
Practice Address - City:BLISSFIELD
Practice Address - State:MI
Practice Address - Zip Code:49228-1225
Practice Address - Country:US
Practice Address - Phone:517-215-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-13
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI750101329225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty