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General NPI Number Information
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NPI Number | 1154195113
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Entity Type | Organization
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Legal Business Name | MYO MASSAGE STUDIO ALASKA
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Dates
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Enumeration Date | 11/09/2023
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 43335 KALIFORNSKY BEACH RD STE 16H
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City | SOLDOTNA
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State | AK
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Zip | 99669-8250
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Country | US
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Telephone | 907-953-7874
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Fax |
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Provider Business Mailing Address
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Address Line | 53140 N SHORE CT
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City | KENAI
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State | AK
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Zip | 99611-9642
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Country | US
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Telephone | 907-953-7874
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATIE TALLENT MAXWELL
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Credential | LMT
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Telephone | 907-953-7874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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