Provider Demographics
NPI:1831639269
Name:HUTKA, TRINITY MICHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:TRINITY
Middle Name:MICHELLE
Last Name:HUTKA
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 1:9130 ELIM ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3828
Mailing Address - Country:US
Mailing Address - Phone:907-350-6196
Mailing Address - Fax:907-644-9036
Practice Address - Street 1:11725 INSPIRATION DR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7918
Practice Address - Country:US
Practice Address - Phone:907-350-6196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-05
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101970225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist