Doctor Name: | MRS. JEANETTE STACK |
NPI Number: | 1548407497 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMP |
License Number: | MA 00014238 |
Business Practice Address: | 10421 Vfw Rd Ste 101 Eagle River, AK - 995778075 |
Business Phone Number: | 9073517191 |
Business Fax Number: | 9076224001 |
Mailing Address: | 24712 Teal Loop, CHUGIAK |
State: | AK |
Postal Code: | 995675114 |
Phone Number: | 9073517191 |
Fax Number: | 9076224001 |
NPI Enumeration Date: | 01/14/2009 |
NPI Last Update Date: | 01/14/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA 00014238 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |