Healthcare Provider Details

I. General information

NPI: 1417460254
Provider Name (Legal Business Name): TAMMY MICHELLE SMITH MANUAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 OLD SEWARD HWY STE 1000
ANCHORAGE AK
99503-6065
US

IV. Provider business mailing address

4007 OLD SEWARD HWY STE 1000
ANCHORAGE AK
99503-6065
US

V. Phone/Fax

Practice location:
  • Phone: 907-646-7653
  • Fax:
Mailing address:
  • Phone: 907-646-7653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number47-2106017
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: