Provider Demographics
NPI:1942549761
Name:WATSON-FOOR, KRISTI MICHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:MICHELLE
Last Name:WATSON-FOOR
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 1:4736 HIGHWAY 17 BYP S
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-5616
Mailing Address - Country:US
Mailing Address - Phone:843-444-9355
Mailing Address - Fax:843-294-0019
Practice Address - Street 1:3560 JORDANVILLE RD
Practice Address - Street 2:
Practice Address - City:GALIVANTS FERRY
Practice Address - State:SC
Practice Address - Zip Code:29544-8540
Practice Address - Country:US
Practice Address - Phone:843-742-7852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6014225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist