Provider Demographics
NPI:1982954525
Name:KRUSKA, CRYSTAL R (LMP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:R
Last Name:KRUSKA
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 1:8033 W GRANDRIDGE BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7159
Mailing Address - Country:US
Mailing Address - Phone:509-783-1899
Mailing Address - Fax:509-783-1898
Practice Address - Street 1:8033 W GRANDRIDGE BLVD
Practice Address - Street 2:STE C
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7159
Practice Address - Country:US
Practice Address - Phone:509-783-1899
Practice Address - Fax:509-783-1898
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60288926225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60288926OtherLICENSE