CRYSTAL BETHEA - NPI 1093218562 - Massage Therapist in Kissimmee, FL

Q: What is the provider's specialty?

The provider's specialty is Massage Therapist with taxonomy code 225700000X.

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About Crystal Bethea NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CRYSTAL BETHEA (NPI 1093218562) is an individual massage therapist in Kissimmee, Florida, licensed in Florida (MA58296) and active in the NPI registry since March 2018. She maintains a secondary practice location in Kissimmee.Information from the official NPPES registry record.

NPPES Registry Identity

NPI1093218562

Entity TypeIndividualFemale

Primary Taxonomy225700000X

Provider Legal NameCRYSTAL BETHEA

Location Address395 VILLAGE DRKissimmee, FL 34759-4012

Mailing Address2717 Eagle Canyon Dr SKissimmee, FL 34746-3170 · (407) 914-9168

Phone(407) 914-9168

Fax(863) 313-9293

Sole ProprietorNo

Enumeration DateMarch 12, 2018

Last NPPES UpdateSeptember 12, 20257 updates tracked since enumeration

NPPES CertifiedJuly 23, 2024

✔ NPI 1093218562 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMassage TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers

Taxonomy Code225700000X

License✔ Licensed in FL · MA58296

Definition

An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.

395 VILLAGE DR, Kissimmee, FL 34759

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Secondary Practice Location 1

Location 11060 Cypress Pkwy Ste 104Kissimmee, FL 34759-3328 · Phone (407) 914-9168 ext. 1 · Fax (407) 337-8005

Other Identifiers 1

Medicaid112243500FL