Provider Demographics
NPI:1477911600
Name:LORTIE, AMY ALISA (LMT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ALISA
Last Name:LORTIE
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 1:211 4TH ST
Mailing Address - Street 2:STE. 107
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1191
Mailing Address - Country:US
Mailing Address - Phone:907-321-5689
Mailing Address - Fax:
Practice Address - Street 1:211 4TH ST
Practice Address - Street 2:STE. 107
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1191
Practice Address - Country:US
Practice Address - Phone:907-321-5689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK104631225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist