Individual
MRS. CRYSTAL LYNN BLANKENSHIP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASSAGE THERAPIST
Contact information
Practice address
1200 W AVON BLVD, AVON PARK, FL 33825-8343
(863) 440-1535
Mailing address
3400 GARRARD RD, FORT MEADE, FL 33841-9534
(863) 440-1535
Taxonomy
Speciality
Code
Description
License number
State
175L00000X
Homeopath
Primary
MA59595
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA 59550
MASSAGE STATE ID
FL
Enumeration date
09/01/2010
Last updated
09/01/2010
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