=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144993569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOMER MASSAGE THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2021
-----------------------------------------------------
Last Update Date | 03/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1104 OCEAN DR UNIT A
-----------------------------------------------------
City | HOMER
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99603-7919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-299-8284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 407
-----------------------------------------------------
City | ANCHOR POINT
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99556-0407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-299-8284
-----------------------------------------------------
Fax | 206-312-3201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROSALIE RICE
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 907-299-8284
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------