Provider Demographics
NPI:1710367834
Name:MACEIRA, CRYSTAL K (LMT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:K
Last Name:MACEIRA
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 1:3791 WOODRIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-6477
Mailing Address - Country:US
Mailing Address - Phone:406-616-2599
Mailing Address - Fax:
Practice Address - Street 1:3791 WOODRIDGE TRL
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-6477
Practice Address - Country:US
Practice Address - Phone:406-616-2599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13729225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist