Provider Demographics
NPI:1013231356
Name:CRITES, MARIA (LMT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:CRITES
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 1:118 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-1833
Mailing Address - Country:US
Mailing Address - Phone:907-590-7495
Mailing Address - Fax:
Practice Address - Street 1:600 3RD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3511
Practice Address - Country:US
Practice Address - Phone:907-590-7495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK906273225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist