Provider Demographics
NPI:1376705277
Name:POWELL, KRISTI ASTRID
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:ASTRID
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KRISTINA
Other - Middle Name:ASTRID
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NCMT BS
Mailing Address - Street 1:PO BOX 665
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:GA
Mailing Address - Zip Code:30527-0641
Mailing Address - Country:US
Mailing Address - Phone:678-617-4992
Mailing Address - Fax:
Practice Address - Street 1:1709 CLEVELAND HWY
Practice Address - Street 2:BODYWORKS
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-532-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT001972225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist