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NPI Code Detail

MEDICARE: EMMALIE HENDRICKS LMP

MEDICARE: EMMALIE HENDRICKS LMP
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
1225700000XMassage Therapist

General Provider Information

NPI Number : 1043693880
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMALIE HENDRICKS LMP
Provider Business Mailing Address
First Line : 2031 S KAYE MARIE DR
Second Line :
City : PALMER
State : AK
Zip : 99645-9067
Country : US
Telephone Number : 907-750-8171
Fax Number :
Provider Business Practice Location Address
First Line : 13135 OLD GLENN HWY
Second Line :
City : EAGLE RIVER
State : AK
Zip : 99577-7584
Country : US
Telephone Number : 907-696-9090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2015
Last Update Date : 01/14/2026

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Directions to “ EMMALIE HENDRICKS LMP” Practice Location

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