Provider Demographics
NPI:1104437821
Name:DELGADO MCCRAW, CRYSTAL (LMT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:DELGADO MCCRAW
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:MCCRAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8339 WEYBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-6198
Mailing Address - Country:US
Mailing Address - Phone:904-403-9940
Mailing Address - Fax:
Practice Address - Street 1:869 STOCKTON ST STE 8
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3590
Practice Address - Country:US
Practice Address - Phone:904-395-4288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA81157225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist