MEDICARE: DEBORAH FAYE EDWARD 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	1071819	AK

General Provider Information

NPI Number	:	1104315696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH FAYE EDWARD LMT

Provider Business Mailing Address
First Line	:	2521 E MOUNTAIN VILLAGE DR STE B
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7377
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 ARCTIC BLVD STE 201
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-5702
Country	:	US
Telephone Number	:	907-715-1224
Fax Number	:

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

Provider Enumeration Date	:	05/09/2018
Last Update Date	:	05/09/2018

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