Provider Demographics
NPI:1619442027
Name:TEUTSCH, GWENDOLYNNE ANN (CMT)
Entity Type:Individual
Prefix:
First Name:GWENDOLYNNE
Middle Name:ANN
Last Name:TEUTSCH
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5661 E REVOLUTIONARY WAY
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6724
Mailing Address - Country:US
Mailing Address - Phone:907-354-7169
Mailing Address - Fax:
Practice Address - Street 1:5661 E REVOLUTIONARY WAY
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6724
Practice Address - Country:US
Practice Address - Phone:907-354-7169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK133905225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty