Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 133072 | AK |
NPI | 1013496009 |
---|---|
Provider Name | Christine Marie Childers |
First Address | Anchorage, AK 99508-5334 |
Second Address | Anchorage, AK 99508-5334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2018 |
Last Update Date | 09/08/2018 |