Provider Demographics
NPI:1801387352
Name:PRESL, KRYSTAL (LMT MMP)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:PRESL
Suffix:
Gender:F
Credentials:LMT MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MANCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46962-1807
Mailing Address - Country:US
Mailing Address - Phone:260-440-4155
Mailing Address - Fax:
Practice Address - Street 1:121 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH MANCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46962-1822
Practice Address - Country:US
Practice Address - Phone:260-306-3057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21806462225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1801387352OtherMEDICAL MASSAGE CERTIFICATION