Provider Demographics
NPI:1912484577
Name:CINELLI, CRYSTAL A (LMT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:A
Last Name:CINELLI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 FOUNDRY ST APT 21-4
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1719
Mailing Address - Country:US
Mailing Address - Phone:508-685-6055
Mailing Address - Fax:
Practice Address - Street 1:41 FOUNDRY ST APT 21-4
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1719
Practice Address - Country:US
Practice Address - Phone:508-685-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9332225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist