Provider Demographics
NPI:1366963720
Name:KOOKESH, KRISTI LEIGH (LICENSED MASSAGE THE)
Entity type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:LEIGH
Last Name:KOOKESH
Suffix:
Gender:F
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10004 GLACIER HWY STE B
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801
Mailing Address - Country:US
Mailing Address - Phone:907-500-4888
Mailing Address - Fax:907-891-7376
Practice Address - Street 1:10004 GLACIER HWY STE B
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-500-4888
Practice Address - Fax:907-891-7376
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
102007225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist