Provider Demographics
NPI:1093162786
Name:HANDS OF LIFE MASSAGE THEARPY, LLC
Entity Type:Organization
Organization Name:HANDS OF LIFE MASSAGE THEARPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ZOEY
Authorized Official - Middle Name:AILA
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:907-388-5965
Mailing Address - Street 1:PO BOX 81521
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-1521
Mailing Address - Country:US
Mailing Address - Phone:907-388-5965
Mailing Address - Fax:
Practice Address - Street 1:565 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3688
Practice Address - Country:US
Practice Address - Phone:907-388-5965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK107352174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty