Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 11630 | AK |
NPI | 1013439678 |
---|---|
Provider Name | Barbara Ann Leder |
First Address | Fairbanks, AK 99701-4609 |
Second Address | Fairbanks, AK 99798 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2017 |
Last Update Date | 14/07/2017 |