Individual
KRYSTAL MARIE WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
30 7TH ST W, DICKINSON, ND 58601-4335
(208) 739-6456
Mailing address
427 TWEETEN PL, DICKINSON, ND 58601-6235
(208) 739-6456
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
1536
ND
Other
Enumeration date
12/01/2023
Last updated
12/01/2023
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