Healthcare Provider Details

I. General information

NPI: 1831639269
Provider Name (Legal Business Name): TRINITY MICHELLE HUTKA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2017
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11725 INSPIRATION DR
EAGLE RIVER AK
99577-7918
US

IV. Provider business mailing address

9130 ELIM ST
ANCHORAGE AK
99507-3828
US

V. Phone/Fax

Practice location:
  • Phone: 907-350-6196
  • Fax:
Mailing address:
  • Phone: 907-350-6196
  • Fax: 907-644-9036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number101970
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: