Provider Demographics
NPI:1184149213
Name:KRAFT, JASMIN MARIE (LMT)
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:MARIE
Last Name:KRAFT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JASMIN
Other - Middle Name:MARIE
Other - Last Name:TIDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1941 PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-2752
Mailing Address - Country:US
Mailing Address - Phone:907-888-9210
Mailing Address - Fax:
Practice Address - Street 1:308 OLD STEESE HWY
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3126
Practice Address - Country:US
Practice Address - Phone:907-451-7246
Practice Address - Fax:907-451-7244
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist