Provider Demographics
NPI:1922763853
Name:REYES, CRYSTAL DEL CARMEN (LMT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DEL CARMEN
Last Name:REYES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:DEL CARMEN
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:3 DUNWOODY PARK STE 112
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6709
Mailing Address - Country:US
Mailing Address - Phone:404-444-4363
Mailing Address - Fax:
Practice Address - Street 1:3 DUNWOODY PARK STE 112
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6709
Practice Address - Country:US
Practice Address - Phone:404-444-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT013574225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist