Provider Demographics
NPI:1699434993
Name:REYNA, KRYSTAL (LMT)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:REYNA
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 1:6921 E GARTH CIR STE B
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-5922
Mailing Address - Country:US
Mailing Address - Phone:907-745-5444
Mailing Address - Fax:907-745-3780
Practice Address - Street 1:6921 E GARTH CIR STE B
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-5922
Practice Address - Country:US
Practice Address - Phone:907-745-5444
Practice Address - Fax:907-745-3780
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist