Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 7556535 | AK |
NPI | 1003484569 |
---|---|
Provider Name | Eli Kreuzenstein |
First Address | Eagle River, AK 99577-8250 |
Second Address | Anchorage, AK 99515-2029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2021 |
Last Update Date | 11/06/2021 |