MEDICARE: CLIFFORD AMBRO LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	939169	AK

General Provider Information

NPI Number	:	1013332824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLIFFORD AMBRO LMT

Provider Business Mailing Address
First Line	:	2440 E TUDOR RD # 144
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-1185
Country	:	US
Telephone Number	:	907-244-6313
Fax Number	:

Provider Business Practice Location Address
First Line	:	2207 E TUDOR RD STE 33
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-1069
Country	:	US
Telephone Number	:	907-244-6313
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2014
Last Update Date	:	03/03/2014

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Directions to “ CLIFFORD AMBRO LMT” Practice Location

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