Provider Demographics
NPI:1619357142
Name:CRESWELL, KARISSA JOY (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KARISSA
Middle Name:JOY
Last Name:CRESWELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 CUBERO DR NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3842
Mailing Address - Country:US
Mailing Address - Phone:505-999-7144
Mailing Address - Fax:
Practice Address - Street 1:5910 CUBERO DR NE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3842
Practice Address - Country:US
Practice Address - Phone:505-999-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5241174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM5241OtherNM MASSAGE THERAPY BOARD