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General NPI Number Information
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NPI Number | 1366076119
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Entity Type | Organization
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Legal Business Name | EXCLUSIVELY INCUSIVE LLC
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Dates
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Enumeration Date | 03/02/2020
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Last Update Date | 03/02/2020
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Provider Practice Location Address
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Address Line | 751 OLD RICHARDSON HWY STE 101
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City | FAIRBANKS
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State | AK
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Zip | 99701-7802
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Country | US
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Telephone | 907-251-1331
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Fax | 855-414-4818
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Provider Business Mailing Address
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Address Line | 751 OLD RICHARDSON HWY STE 101
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City | FAIRBANKS
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State | AK
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Zip | 99701-7802
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Country | US
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Telephone | 907-251-1331
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Fax | 855-414-4818
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Authorized Official
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Title or Position | PARTNER
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Name | CEAN WHITMARSH
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Credential | LMT, MMP
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Telephone | 907-251-0055
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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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