Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 111022 | AK |
NPI | 1003342999 |
---|---|
Provider Name | Kristin Tri |
First Address | Eagle River, AK 99577-8531 |
Second Address | Eagle River, AK 99577-8531 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2017 |
Last Update Date | 11/05/2017 |