Krystal Maiden, LCMT, LE

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

227014737 Issued in IL

Practice address

17222 Harlem Ave
Tinley Park, IL 60477-3368

Phone

(708) 468-8957

NPI assigned

Sep 23, 2022

Last updated

Sep 23, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: contact@ndulj.net

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663891200000",
    "number": "1760105787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2805 140TH PL",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604063352",
            "telephone_number": "773-879-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17222 HARLEM AVE",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604773368",
            "telephone_number": "708-468-8957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAIDEN",
        "first_name": "KRYSTAL",
        "credential": "LCMT, LE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-23",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "IL",
            "license": "227014737",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "contact@ndulj.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "17222 Harlem Ave",
            "city": "Tinley Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604773368",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jennifer Maureen Lydon, OD
• Danielle Lyon
• Samantha Maciaga
• Mary Beth Madden Damm, MA, CCC-SLP
• Isabella Magana
• Dharvin Maisuria, PHARM.D.
• Malhotra LLC
• Bruce C Malm, MD
• Latosha C Malone, LE
• Sara Mandernach, M.S.

• Massage Therapist in Tinley Park, IL
• Providers in Tinley Park, IL by specialty
• Massage Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.