Individual
CRYSTAL ANN LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
5814 GRAHAM AVE STE 101, SUMNER, WA 98390-2728
(253) 891-7093
(951) 973-7216
Mailing address
5814 GRAHAM AVE STE 101, SUMNER, WA 98390-2728
(253) 891-7093
(951) 973-7216
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA60879902
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA60879902
MASSAGE THERAPY LICENSE
WA
Enumeration date
08/02/2018
Last updated
08/02/2018
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