Healthcare Provider Details

I. General information

NPI: 1053224550
Provider Name (Legal Business Name): INNATE WELLNESS & MASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 E WESTPOINT DR STE B10-A
WASILLA AK
99654-7191
US

IV. Provider business mailing address

17152 W PARKS HWY
HOUSTON AK
99694-9800
US

V. Phone/Fax

Practice location:
  • Phone: 907-982-4565
  • Fax:
Mailing address:
  • Phone: 907-982-4565
  • 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: CHARITY ROSE MOLNAR
Title or Position: MASSAGE THERAPIST
Credential: LMT
Phone: 907-982-4565