Healthcare Provider Details

I. General information

NPI: 1780268797
Provider Name (Legal Business Name): KATHERYNE CHRISTIAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12812 OLD GLENN HWY STE A8
EAGLE RIVER AK
99577-7003
US

IV. Provider business mailing address

12812 OLD GLENN HWY STE A8
EAGLE RIVER AK
99577-7003
US

V. Phone/Fax

Practice location:
  • Phone: 907-696-8020
  • Fax: 907-696-8021
Mailing address:
  • Phone: 907-696-8020
  • Fax: 907-696-8021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number169012
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: