Provider Demographics
NPI:1871762179
Name:WELD, CHRYSTAL RENEE (LMP)
Entity type:Individual
Prefix:MRS
First Name:CHRYSTAL
Middle Name:RENEE
Last Name:WELD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1092
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:WA
Mailing Address - Zip Code:98541-1092
Mailing Address - Country:US
Mailing Address - Phone:360-470-2080
Mailing Address - Fax:360-482-0018
Practice Address - Street 1:319 WEST MAIN ST.
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541
Practice Address - Country:US
Practice Address - Phone:360-482-3044
Practice Address - Fax:360-482-0018
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025248172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist