Provider Demographics
NPI:1336479427
Name:SAINT ONGE, CRYSTAL MORNING (LMT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MORNING
Last Name:SAINT ONGE
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 1:2305 SE YAMHILL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2848
Mailing Address - Country:US
Mailing Address - Phone:503-381-1905
Mailing Address - Fax:
Practice Address - Street 1:2505 SE 11TH AVE
Practice Address - Street 2:SUITE 221
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1061
Practice Address - Country:US
Practice Address - Phone:503-381-1905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10004225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist