Provider Demographics
NPI:1184168064
Name:WILLIAMS, CRYSTAL LEE (CMT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:LEE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8285 BIRCHVIEW RD
Mailing Address - Street 2:
Mailing Address - City:GRASSTON
Mailing Address - State:MN
Mailing Address - Zip Code:55030-2109
Mailing Address - Country:US
Mailing Address - Phone:612-298-7310
Mailing Address - Fax:320-223-6223
Practice Address - Street 1:750 MAIN ST S
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-1665
Practice Address - Country:US
Practice Address - Phone:320-591-8232
Practice Address - Fax:320-223-6223
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-12
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist