Provider Demographics
NPI:1477024693
Name:KAUFMAN, JANANN (NCLMT, NCMTPT)
Entity Type:Individual
Prefix:
First Name:JANANN
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:NCLMT, NCMTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-1379
Mailing Address - Country:US
Mailing Address - Phone:907-244-1284
Mailing Address - Fax:
Practice Address - Street 1:11200 FOREST DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-1379
Practice Address - Country:US
Practice Address - Phone:907-244-1284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1040104225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1040104OtherALASKA STATE MASSAGE BUSINESS LICENSE