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NPI Code Detail

MEDICARE: TIANA AVERY LMT

MEDICARE: TIANA AVERY 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
1225700000XMassage Therapist133096AK

General Provider Information

NPI Number : 1558832246
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIANA AVERY LMT
Provider Business Mailing Address
First Line : 16928 PARK PLACE ST APT 3
Second Line :
City : EAGLE RIVER
State : AK
Zip : 99577-7881
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13135 OLD GLENN HWY STE 100
Second Line :
City : EAGLE RIVER
State : AK
Zip : 99577-7584
Country : US
Telephone Number : 715-415-1925
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2018
Last Update Date : 01/30/2026

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Directions to “ TIANA AVERY LMT” Practice Location

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