Provider Demographics
NPI:1962787051
Name:KRAFT, ALYSSA LEIGH (LMT)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:LEIGH
Last Name:KRAFT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:212 S BROADWAY STE 4
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3867
Mailing Address - Country:US
Mailing Address - Phone:701-720-9561
Mailing Address - Fax:701-837-7962
Practice Address - Street 1:212 S BROADWAY STE 4
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3867
Practice Address - Country:US
Practice Address - Phone:701-720-9561
Practice Address - Fax:701-837-7962
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND928225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist