Provider Demographics
NPI:1295216687
Name:JUENKE, JANET LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LYNN
Last Name:JUENKE
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:PO BOX 82113
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-2113
Mailing Address - Country:US
Mailing Address - Phone:907-750-1319
Mailing Address - Fax:888-965-4085
Practice Address - Street 1:615 O'LEARY RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99712
Practice Address - Country:US
Practice Address - Phone:907-750-1319
Practice Address - Fax:888-965-4085
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK136529225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty