MEDICARE: ELKE BELLE ANGELLE LIBERTI LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	213554	AK

General Provider Information

NPI Number	:	1275300220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELKE BELLE ANGELLE LIBERTI LMT

Provider Business Mailing Address
First Line	:	3520 CORONA CIR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99517-1485
Country	:	US
Telephone Number	:	907-744-3282
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 HOLLYWOOD DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99501-1317
Country	:	US
Telephone Number	:	907-744-3282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	12/11/2023

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