Provider Demographics
NPI:1497194989
Name:STOOTS, CRYSTAL LYNN (CMT)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LYNN
Last Name:STOOTS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 BRAMBLETON AVE
Mailing Address - Street 2:SUITE 9B
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6526
Mailing Address - Country:US
Mailing Address - Phone:540-797-2274
Mailing Address - Fax:
Practice Address - Street 1:3536 BRAMBLETON AVE
Practice Address - Street 2:SUITE 9B
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6526
Practice Address - Country:US
Practice Address - Phone:540-797-2274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019010238174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist