Provider Demographics
NPI:1194164970
Name:CRAFT, JOSHUA DAVID (LMT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DAVID
Last Name:CRAFT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2291 N KELSO LN
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-8891
Mailing Address - Country:US
Mailing Address - Phone:907-745-2727
Mailing Address - Fax:907-746-8707
Practice Address - Street 1:1901 N HEMMER RD
Practice Address - Street 2:STE 209
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:907-745-2727
Practice Address - Fax:907-746-8707
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0010870225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist