Provider Demographics
NPI:1477388445
Name:HOGUE, CRYSTAL (LMBT, NMT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:HOGUE
Suffix:
Gender:F
Credentials:LMBT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 SUMNER CT
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-6454
Mailing Address - Country:US
Mailing Address - Phone:336-870-8130
Mailing Address - Fax:
Practice Address - Street 1:3523 ARCHDALE RD
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-2715
Practice Address - Country:US
Practice Address - Phone:336-870-8130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-07
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21505225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist