Provider Demographics
NPI:1396997896
Name:CHASE, CRYSTAL ELAINE (LMT,NCTMB)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ELAINE
Last Name:CHASE
Suffix:
Gender:F
Credentials:LMT,NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3127
Mailing Address - Country:US
Mailing Address - Phone:503-577-7007
Mailing Address - Fax:
Practice Address - Street 1:478 2ND ST
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3127
Practice Address - Country:US
Practice Address - Phone:503-577-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13088225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist