Provider Demographics
NPI:1649412750
Name:COPELAND, CHRYSTAL (LMT)
Entity Type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:
Last Name:COPELAND
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 1:10900 MENAUL BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2453
Mailing Address - Country:US
Mailing Address - Phone:505-205-9910
Mailing Address - Fax:505-292-3181
Practice Address - Street 1:10900 MENAUL BLVD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2453
Practice Address - Country:US
Practice Address - Phone:505-205-9910
Practice Address - Fax:505-292-3181
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6324225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist