Provider Demographics
NPI:1427856368
Name:PAISLEY, KRYSTAL IMANI (AS, LMT)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:IMANI
Last Name:PAISLEY
Suffix:
Gender:
Credentials:AS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6268 W SAMPLE RD UNIT 403
Mailing Address - Street 2:SUITE 446
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3272
Mailing Address - Country:US
Mailing Address - Phone:754-715-2361
Mailing Address - Fax:
Practice Address - Street 1:4236 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2102
Practice Address - Country:US
Practice Address - Phone:904-381-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA99736225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist