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NPI Code Detail

MEDICARE: DOMNA REUTOV

MEDICARE:   DOMNA  REUTOV
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
1225700000XMassage Therapist101777AK

General Provider Information

NPI Number : 1710357827
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMNA REUTOV
Provider Business Mailing Address
First Line : 6085 SPRUCE MEADOWS LOOP
Second Line :
City : ANCHORAGE
State : AK
Zip : 99507-4712
Country : US
Telephone Number : 907-399-1190
Fax Number :
Provider Business Practice Location Address
First Line : 110 W TUDOR RD STE D
Second Line :
City : ANCHORAGE
State : AK
Zip : 99503-7247
Country : US
Telephone Number : 907-334-6492
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2015
Last Update Date : 10/01/2015

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Directions to “ DOMNA REUTOV ” Practice Location

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