Provider Demographics
NPI:1003267295
Name:SWENSON, CATHERINE (LMT, CMT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:SWENSON
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3295 TRANQUILITY CT
Mailing Address - Street 2:#3
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-6380
Mailing Address - Country:US
Mailing Address - Phone:907-687-7609
Mailing Address - Fax:
Practice Address - Street 1:1118 2ND AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4228
Practice Address - Country:US
Practice Address - Phone:907-456-6213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101430225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist