Healthcare Provider Details

I. General information

NPI: 1366351041
Provider Name (Legal Business Name): ALICIA DEANNE BEAVERS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5461 E MAYFLOWER LN STE 6
WASILLA AK
99654-7892
US

IV. Provider business mailing address

766 S WOLF RD
WASILLA AK
99623-4711
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-6688
  • Fax:
Mailing address:
  • Phone: 907-201-1066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number257702
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: