Provider Demographics
NPI:1700229184
Name:REIS, CRYSTAL D (LMT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
Last Name:REIS
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 1:44 S KINTNER PKWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074
Mailing Address - Country:US
Mailing Address - Phone:614-578-6286
Mailing Address - Fax:
Practice Address - Street 1:44 S KINTNER PKWY
Practice Address - Street 2:SUITE E
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074
Practice Address - Country:US
Practice Address - Phone:614-578-6286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.019426225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist