Provider Demographics
NPI:1487183059
Name:KVASNIKOFF, DEBRA MARIE (LMT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:MARIE
Last Name:KVASNIKOFF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:175 N BINKLEY ST UNIT 160
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-0090
Mailing Address - Country:US
Mailing Address - Phone:480-773-2418
Mailing Address - Fax:866-338-1091
Practice Address - Street 1:198 W MARYDALE AVE
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7501
Practice Address - Country:US
Practice Address - Phone:480-773-2418
Practice Address - Fax:866-338-1091
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK121258225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist