Healthcare Provider Details

I. General information

NPI: 1952835431
Provider Name (Legal Business Name): GLACIER SALT CAVE & SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 GLACIER HWY
JUNEAU AK
99801-9507
US

IV. Provider business mailing address

5450 GLACIER HWY
JUNEAU AK
99801
US

V. Phone/Fax

Practice location:
  • Phone: 907-500-9001
  • Fax:
Mailing address:
  • Phone: 907-500-9001
  • 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: CHARLENE M BOEHM
Title or Position: OWNER
Credential:
Phone: 907-957-1257