Individual
KRISTEN PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1212 W MYSTERY AVE, WASILLA, AK 99654-6335
(907) 521-8002
Mailing address
PO BOX 728, WILLOW, AK 99688-0728
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
145079
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
145079
MASSAGE THERAPIST
AK
Enumeration date
10/04/2019
Last updated
10/04/2019
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