Provider Demographics
NPI:1003484569
Name:KREUZENSTEIN, ELI
Entity Type:Individual
Prefix:
First Name:ELI
Middle Name:
Last Name:KREUZENSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17823 MEADOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8250
Mailing Address - Country:US
Mailing Address - Phone:907-862-4853
Mailing Address - Fax:
Practice Address - Street 1:1000 E DIMOND BLVD STE 202
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2029
Practice Address - Country:US
Practice Address - Phone:907-349-4212
Practice Address - Fax:907-344-3381
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7556535225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist