Provider Demographics
NPI:1609193010
Name:CRESAP, DEANNA KAY (LMT, CMTPT)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:KAY
Last Name:CRESAP
Suffix:
Gender:F
Credentials:LMT, CMTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22135 AURORA BOREALIS RD
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-6163
Mailing Address - Country:US
Mailing Address - Phone:907-229-9935
Mailing Address - Fax:
Practice Address - Street 1:22135 AURORA BOREALIS RD
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-6163
Practice Address - Country:US
Practice Address - Phone:907-229-9935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-24
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK922585225700000X
AK952071225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist