Provider Demographics
NPI:1588033989
Name:LEWIS, CRYSTAL
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 SAN MATEO BLVD NE
Mailing Address - Street 2:STE F
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3165
Mailing Address - Country:US
Mailing Address - Phone:505-888-4044
Mailing Address - Fax:505-888-1932
Practice Address - Street 1:2620 SAN MATEO BLVD NE
Practice Address - Street 2:STE F
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3165
Practice Address - Country:US
Practice Address - Phone:505-888-4044
Practice Address - Fax:505-888-1932
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist