Healthcare Provider Details

I. General information

NPI: 1073374070
Provider Name (Legal Business Name): JOSHUA RYAN CRONAN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12812 OLD GLENN HWY STE A8
EAGLE RIVER AK
99577-7003
US

IV. Provider business mailing address

17905 BEAUJOLAIS DR
EAGLE RIVER AK
99577-7001
US

V. Phone/Fax

Practice location:
  • Phone: 907-696-8020
  • Fax:
Mailing address:
  • Phone: 907-980-5446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number146354
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: