Provider Demographics
NPI:1245692797
Name:BRANCHE, SHAUNA (LMT, MQT)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:BRANCHE
Suffix:
Gender:F
Credentials:LMT, MQT
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, MQT
Mailing Address - Street 1:610 W 2ND AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2151
Mailing Address - Country:US
Mailing Address - Phone:907-306-7956
Mailing Address - Fax:
Practice Address - Street 1:610 W 2ND AVE
Practice Address - Street 2:STE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2151
Practice Address - Country:US
Practice Address - Phone:907-306-7956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK107372225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist