Provider Demographics
NPI:1851188379
Name:WHITE, CRISELDA EHONG (LMT)
Entity type:Individual
Prefix:
First Name:CRISELDA
Middle Name:EHONG
Last Name:WHITE
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 QUEST PKWY STE 6
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2666
Mailing Address - Country:US
Mailing Address - Phone:512-817-3008
Mailing Address - Fax:
Practice Address - Street 1:910 QUEST PKWY STE 6
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2666
Practice Address - Country:US
Practice Address - Phone:737-414-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
TX129702225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty