Provider Demographics
NPI:1487906921
Name:SWANSON, CRYSTAL AYLENE (RMT)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:AYLENE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6815 ASHLEY DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-1629
Mailing Address - Country:US
Mailing Address - Phone:719-216-6072
Mailing Address - Fax:
Practice Address - Street 1:6815 ASHLEY DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-1629
Practice Address - Country:US
Practice Address - Phone:719-203-5793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
COMT-11664225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula