Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 421131 | AK |
NPI | 1003284662 |
---|---|
Provider Name | Ms. Melissa Anne Mitchell |
First Address | Anchorage, AK 99518-2410 |
Second Address | Anchorage, AK 99518-2410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2015 |
Last Update Date | 11/09/2015 |