Provider Demographics
NPI:1376946392
Name:KIVA CRUTCHER
Entity Type:Organization
Organization Name:KIVA CRUTCHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIVA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:423-704-1171
Mailing Address - Street 1:1127 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5021
Mailing Address - Country:US
Mailing Address - Phone:423-704-1171
Mailing Address - Fax:
Practice Address - Street 1:1127 PLAZA DR
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5021
Practice Address - Country:US
Practice Address - Phone:423-704-1171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-04
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8241225700000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty