Provider Demographics
NPI:1013759620
Name:GEORGE, CHRYSTAL FEION (LMT/CMMT)
Entity type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:FEION
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LMT/CMMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 HYLAND CIR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4650
Mailing Address - Country:US
Mailing Address - Phone:858-602-6725
Mailing Address - Fax:
Practice Address - Street 1:1055 HYLAND CIR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4650
Practice Address - Country:US
Practice Address - Phone:858-602-6725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-01164P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist