Provider Demographics
NPI:1336737410
Name:KHRISTA FORTUNE
Entity Type:Organization
Organization Name:KHRISTA FORTUNE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMT
Authorized Official - Prefix:
Authorized Official - First Name:KHRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTUNE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:907-538-7990
Mailing Address - Street 1:802 N LANE ST APT 4
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-1744
Mailing Address - Country:US
Mailing Address - Phone:907-538-7990
Mailing Address - Fax:
Practice Address - Street 1:1350 W NORTHERN LIGHTS BLVD STE C
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3614
Practice Address - Country:US
Practice Address - Phone:907-334-8020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty