Healthcare Provider Details

I. General information

NPI: 1962954313
Provider Name (Legal Business Name): KIMBERLY MICHELLE GLASCO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 DENALI ST
ANCHORAGE AK
99503-4041
US

IV. Provider business mailing address

2202 W 47TH AVE
ANCHORAGE AK
99517-3182
US

V. Phone/Fax

Practice location:
  • Phone: 907-677-6953
  • Fax:
Mailing address:
  • Phone: 907-350-9475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number101819
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: