Provider Demographics
NPI:1548717648
Name:BASHORE, CRYSTAL KAY (LMT)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:KAY
Last Name:BASHORE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 RITA LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-5864
Mailing Address - Country:US
Mailing Address - Phone:717-644-1169
Mailing Address - Fax:
Practice Address - Street 1:1000 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7165
Practice Address - Country:US
Practice Address - Phone:717-270-9798
Practice Address - Fax:717-270-9798
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG002865225700000X
PA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty