Individual
CRYSTAL MARY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
977 ROYAL AVE, MEDFORD, OR 97504-6140
(541) 245-4444
(541) 200-2262
Mailing address
1744 E MCANDREWS RD STE D, MEDFORD, OR 97504-5576
(541) 414-0362
(541) 200-2262
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25087
OREGON HEALTH DEPARTMENT
OR
Enumeration date
01/29/2021
Last updated
01/29/2021
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