Provider Demographics
NPI:1255713038
Name:MOSELEY, CRYSTAL RENEE (LMT, MMP)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:RENEE
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7809 UTICA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63133-1141
Mailing Address - Country:US
Mailing Address - Phone:314-255-6485
Mailing Address - Fax:
Practice Address - Street 1:7809 UTICA DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63133-1141
Practice Address - Country:US
Practice Address - Phone:314-255-6485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010011037172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist