MEDICARE: CARYL RICHEY LMT, MMP, MLD-C

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	151515	AK

General Provider Information

NPI Number	:	1992341358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARYL RICHEY LMT, MMP, MLD-C

Provider Business Mailing Address
First Line	:	450 E TUDOR RD STE 104
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-7370
Country	:	US
Telephone Number	:	907-317-3833
Fax Number	:	867-768-9044

Provider Business Practice Location Address
First Line	:	450 E TUDOR RD STE 104
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-7370
Country	:	US
Telephone Number	:	907-317-3833
Fax Number	:	867-768-9044

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

Provider Enumeration Date	:	11/20/2019
Last Update Date	:	10/19/2022

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