Provider Demographics
NPI:1093329286
Name:ALLENDER, KRYSTALL (MA68763)
Entity Type:Individual
Prefix:MISS
First Name:KRYSTALL
Middle Name:
Last Name:ALLENDER
Suffix:
Gender:F
Credentials:MA68763
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 SW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4426
Mailing Address - Country:US
Mailing Address - Phone:360-250-1907
Mailing Address - Fax:
Practice Address - Street 1:2706 SW 3RD AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-4426
Practice Address - Country:US
Practice Address - Phone:360-250-1907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA68763225700000X
WAMA68763225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty