Provider Demographics
NPI:1841957370
Name:THOMPSON, KRISTY (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3475 LA MESA DR
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94542-2522
Mailing Address - Country:US
Mailing Address - Phone:928-279-7295
Mailing Address - Fax:
Practice Address - Street 1:3475 LA MESA DR
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94542-2522
Practice Address - Country:US
Practice Address - Phone:928-279-7295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73792225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist