Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 101430 | AK |
NPI | 1003267295 |
---|---|
Provider Name | Catherine Swenson |
First Address | North Pole, AK 99705-6380 |
Second Address | Fairbanks, AK 99701-4228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2016 |
Last Update Date | 29/06/2016 |