Provider Demographics
NPI:1720625247
Name:CRAFT MASSAGE & WELLNESS OF WILMINGTON
Entity Type:Organization
Organization Name:CRAFT MASSAGE & WELLNESS OF WILMINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-271-4613
Mailing Address - Street 1:3905 INDEPENDENCE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2472
Mailing Address - Country:US
Mailing Address - Phone:910-271-4613
Mailing Address - Fax:
Practice Address - Street 1:3905 INDEPENDENCE BLVD STE C
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2472
Practice Address - Country:US
Practice Address - Phone:910-271-4613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty