Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 906273 | AK |
NPI | 1013231356 |
---|---|
Provider Name | Maria Crites |
First Address | Fairbanks, AK 99712-1833 |
Second Address | Fairbanks, AK 99701-3511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2010 |
Last Update Date | 15/03/2010 |