Provider Demographics
NPI:1639801178
Name:CRIFT, MARIAN ALICIA (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:ALICIA
Last Name:CRIFT
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SAINT RAPHAEL RD
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-9290
Mailing Address - Country:US
Mailing Address - Phone:870-794-7266
Mailing Address - Fax:
Practice Address - Street 1:3104 S CATALPA ST STE 9
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-4869
Practice Address - Country:US
Practice Address - Phone:870-329-1358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8847225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty