Provider Demographics
NPI:1467800672
Name:MILGRAM, JUDY ALLYN
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ALLYN
Last Name:MILGRAM
Suffix:
Gender:F
Credentials:
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 111103
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-1103
Mailing Address - Country:US
Mailing Address - Phone:808-339-1883
Mailing Address - Fax:907-677-1880
Practice Address - Street 1:18640 SNOWY PLOVER CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-6120
Practice Address - Country:US
Practice Address - Phone:808-339-1883
Practice Address - Fax:907-677-1880
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101743225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK101743OtherMASSAGE THERAPIST