Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 127509 | AK |
NPI | 1003306713 |
---|---|
Provider Name | Amerissis Feliz |
First Address | Anchorage, AK 99508-2961 |
Second Address | Anchorage, AK 99508-2961 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2018 |
Last Update Date | 17/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6864988 | DRIVER LICENSE (01) | AK |