Provider Demographics
NPI:1588023238
Name:SHIATSU THERAPY LLC
Entity Type:Organization
Organization Name:SHIATSU THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:907-347-2934
Mailing Address - Street 1:PO BOX 74612
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-4612
Mailing Address - Country:US
Mailing Address - Phone:907-347-2934
Mailing Address - Fax:907-459-8201
Practice Address - Street 1:725 2ND AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4450
Practice Address - Country:US
Practice Address - Phone:907-347-2934
Practice Address - Fax:907-459-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101554225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty