Provider Demographics
NPI:1386026201
Name:WOODRUFF, KRISTAL (BS, LMT)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:BS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 COUNTY ROAD 143
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-8663
Mailing Address - Country:US
Mailing Address - Phone:615-474-9261
Mailing Address - Fax:
Practice Address - Street 1:406 GALLERIA DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5462
Practice Address - Country:US
Practice Address - Phone:615-474-9261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-27
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
MS2333225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174H00000XOther Service ProvidersHealth Educator