Provider Demographics
NPI:1659974582
Name:CRUTCHER, KIVA L (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:KIVA
Middle Name:L
Last Name:CRUTCHER
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 SWANHOLME DR APT L206
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-1517
Mailing Address - Country:US
Mailing Address - Phone:423-704-1171
Mailing Address - Fax:
Practice Address - Street 1:475 SWANHOLME DR APT L206
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-1517
Practice Address - Country:US
Practice Address - Phone:423-704-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8241225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty