Provider Demographics
NPI:1770296444
Name:KRUK, ALEXANDRIA R (LMT)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:R
Last Name:KRUK
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 1:63B COURTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-6303
Mailing Address - Country:US
Mailing Address - Phone:716-327-2220
Mailing Address - Fax:
Practice Address - Street 1:168 ROBINSON ST STE 7
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-6916
Practice Address - Country:US
Practice Address - Phone:716-327-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03231301225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist