Provider Demographics
NPI:1528298882
Name:BLONDELL, CRISTA (LMT)
Entity type:Individual
Prefix:MS
First Name:CRISTA
Middle Name:
Last Name:BLONDELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-2936
Mailing Address - Country:US
Mailing Address - Phone:207-272-5638
Mailing Address - Fax:
Practice Address - Street 1:209 WESTERN AVE UNIT G
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2452
Practice Address - Country:US
Practice Address - Phone:207-272-5638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT3285225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist