Provider Demographics
NPI:1003502014
Name:LINCOLN, CHARLA (LMT)
Entity Type:Individual
Prefix:
First Name:CHARLA
Middle Name:
Last Name:LINCOLN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 CLEVELAND AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-2658
Mailing Address - Country:US
Mailing Address - Phone:530-574-8609
Mailing Address - Fax:
Practice Address - Street 1:6831 JEWEL LAKE RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-2823
Practice Address - Country:US
Practice Address - Phone:907-245-0807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK184611225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist