Healthcare Provider Details

I. General information

NPI: 1063259521
Provider Name (Legal Business Name): MARTINA WOJAK-PIOTROW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 B ST STE 407
ANCHORAGE AK
99503-5944
US

IV. Provider business mailing address

PO BOX 240527
ANCHORAGE AK
99524-0527
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-4421
  • Fax: 907-561-5257
Mailing address:
  • Phone: 907-561-4421
  • Fax: 907-561-5257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number221864
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: