Provider Demographics
NPI:1598996340
Name:KOHLBRENNER, CRYSTAL (MA52011)
Entity Type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:
Last Name:KOHLBRENNER
Suffix:
Gender:F
Credentials:MA52011
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 W WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-1004
Mailing Address - Country:US
Mailing Address - Phone:813-932-0203
Mailing Address - Fax:
Practice Address - Street 1:1824 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-1004
Practice Address - Country:US
Practice Address - Phone:813-932-0203
Practice Address - Fax:813-932-6701
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA52011225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist