Provider Demographics
NPI:1659800233
Name:GIRON, WANNARAT S
Entity Type:Individual
Prefix:
First Name:WANNARAT
Middle Name:S
Last Name:GIRON
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 1:8800 GLACIER HWY STE 223
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8080
Mailing Address - Country:US
Mailing Address - Phone:907-790-4053
Mailing Address - Fax:907-790-4054
Practice Address - Street 1:8800 GLACIER HWY STE 223
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8080
Practice Address - Country:US
Practice Address - Phone:907-790-4053
Practice Address - Fax:907-790-4054
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101415225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist