Chrystle Williefay White, LMT
Individual provider Active NPI Massage Therapist · Big Lake, AK
NPI 1366051203 · NPPES record last updated Jul 27, 2020
Key facts
- NPI
- 1366051203
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 107683 (AK)
- Practice address
- 12900 W Creek Frontage Rd
Big Lake, AK 99623-4880 - Phone
- (907) 892-7335
- Fax
- (907) 737-1429
- NPI assigned
- Jul 27, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107683 | AK | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 107683 | AK | Yes |
Addresses
Primary practice location
12900 W Creek Frontage Rd
Big Lake, AK 99623-4880
Mailing address
PO Box 520794
Big Lake, AK 99652-0794
Phone (907) 231-6299
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 107683 | Other | AK | MASSAGE THERAPIST |
Other providers in Big Lake, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.