Provider Demographics
NPI:1114377330
Name:LANKFORD, CRYSTAL (LMT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:LANKFORD
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 1:4205 MINNESOTA DR
Mailing Address - Street 2:LOWER UNIT
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6449
Mailing Address - Country:US
Mailing Address - Phone:907-602-2386
Mailing Address - Fax:
Practice Address - Street 1:4205 MINNESOTA DR
Practice Address - Street 2:LOWER UNIT
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6449
Practice Address - Country:US
Practice Address - Phone:907-602-2386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-18
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101368225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist