Provider Demographics
NPI:1598354078
Name:CROYLE, ABIGAIL LYNN (LMT MAS-3691)
Entity Type:Individual
Prefix:MISS
First Name:ABIGAIL
Middle Name:LYNN
Last Name:CROYLE
Suffix:
Gender:F
Credentials:LMT MAS-3691
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-5318
Mailing Address - Country:US
Mailing Address - Phone:509-589-1254
Mailing Address - Fax:
Practice Address - Street 1:5809 HIGHWAY 2 STE 105
Practice Address - Street 2:
Practice Address - City:PRIEST RIVER
Practice Address - State:ID
Practice Address - Zip Code:83856-6097
Practice Address - Country:US
Practice Address - Phone:509-589-1254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-3691225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDMAS-3691OtherSTATE OF IDAHO DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSES