Healthcare Provider Details

I. General information

NPI: 1043130206
Provider Name (Legal Business Name): FIRE ISLAND WELLNESS, LLC - DBA FIRE ISLAND MASSAGE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W NORTHERN LIGHTS BLVD STE 104
ANCHORAGE AK
99503-2552
US

IV. Provider business mailing address

7514 TIMBERWOLF CIR
ANCHORAGE AK
99507-4813
US

V. Phone/Fax

Practice location:
  • Phone: 907-727-2326
  • Fax:
Mailing address:
  • Phone: 907-727-2326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARY KLEBS
Title or Position: MANAGING MEMBER
Credential: LMT
Phone: 907-727-2326