Healthcare Provider Details

I. General information

NPI: 1184589681
Provider Name (Legal Business Name): TRISHA ANN DRAKE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5398 E HART LAKE LOOP
WASILLA AK
99654-9356
US

IV. Provider business mailing address

5398 E HART LAKE LOOP
WASILLA AK
99654-9356
US

V. Phone/Fax

Practice location:
  • Phone: 907-301-6005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number101668
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: