Provider Demographics
NPI:1407497209
Name:SUMMERLIN, RACHEL (LMT)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:SUMMERLIN
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 495
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:AK
Mailing Address - Zip Code:99674-0495
Mailing Address - Country:US
Mailing Address - Phone:940-704-7358
Mailing Address - Fax:
Practice Address - Street 1:501 N KNIK ST STE B
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7050
Practice Address - Country:US
Practice Address - Phone:907-373-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK113369225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist