Provider Demographics
NPI:1891581591
Name:FREEL, KRISTALLYNN (LMT)
Entity type:Individual
Prefix:
First Name:KRISTALLYNN
Middle Name:
Last Name:FREEL
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 1:410 RIVERSIDE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-3124
Mailing Address - Country:US
Mailing Address - Phone:970-508-7744
Mailing Address - Fax:
Practice Address - Street 1:5944 S KIPLING PKWY
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-5556
Practice Address - Country:US
Practice Address - Phone:970-508-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.12071225700000X
COMT.0025491225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist