Provider Demographics
NPI:1881193837
Name:CRONK, CRYSTAL SUNSHINE (LMT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:SUNSHINE
Last Name:CRONK
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 1:907 ROOD AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3464
Mailing Address - Country:US
Mailing Address - Phone:970-260-7699
Mailing Address - Fax:
Practice Address - Street 1:125 N 8TH ST UNIT 9
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3533
Practice Address - Country:US
Practice Address - Phone:970-260-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0006761225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist