Individual
CRISTA BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
595 S 7TH ST, COOS BAY, OR 97420-1301
(541) 266-7543
(541) 808-3525
Mailing address
595 S 7TH ST, COOS BAY, OR 97420-1301
(541) 266-7543
(541) 808-3525
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
22830
OR
Other
Enumeration date
09/29/2016
Last updated
09/29/2016
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