Provider Demographics
NPI:1295375970
Name:GREENBERG, ALISHA (LMT)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:GREENBERG
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 1:515 7TH AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4949
Mailing Address - Country:US
Mailing Address - Phone:907-456-4234
Mailing Address - Fax:907-451-9168
Practice Address - Street 1:515 7TH AVE STE 230
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4949
Practice Address - Country:US
Practice Address - Phone:907-456-4234
Practice Address - Fax:907-451-9168
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK139515225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1437273125OtherNPI