Provider Demographics
NPI:1316391477
Name:CRONKHITE, KYLIN MARY-ELIZABETH (LMT)
Entity Type:Individual
Prefix:
First Name:KYLIN
Middle Name:MARY-ELIZABETH
Last Name:CRONKHITE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 MORRIS AVE SE
Mailing Address - Street 2:APT #1
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5324
Mailing Address - Country:US
Mailing Address - Phone:616-295-8883
Mailing Address - Fax:
Practice Address - Street 1:710 MORRIS AVE SE
Practice Address - Street 2:APT #1
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5324
Practice Address - Country:US
Practice Address - Phone:616-295-8883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000758225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist