Provider Demographics
NPI:1407472566
Name:FORTUNE, KHRISTA (LMT)
Entity Type:Individual
Prefix:
First Name:KHRISTA
Middle Name:
Last Name:FORTUNE
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 1:2440 E TUDOR RD
Mailing Address - Street 2:PMB 771
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1185
Mailing Address - Country:US
Mailing Address - Phone:907-244-8900
Mailing Address - Fax:
Practice Address - Street 1:2601 BONIFACE PKWY STE 4
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3144
Practice Address - Country:US
Practice Address - Phone:907-244-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2023-01-25
Deactivation Date:2021-01-06
Deactivation Code:
Reactivation Date:2023-01-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist