Provider Demographics
NPI:1962851048
Name:POAGE, SHEFFANY (LMT)
Entity Type:Individual
Prefix:
First Name:SHEFFANY
Middle Name:
Last Name:POAGE
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 1:189 S BINKLEY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-8061
Mailing Address - Country:US
Mailing Address - Phone:907-262-0801
Mailing Address - Fax:907-262-0860
Practice Address - Street 1:189 S BINKLEY ST STE 101
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8061
Practice Address - Country:US
Practice Address - Phone:907-262-0801
Practice Address - Fax:907-262-0860
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK110929225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist