Provider Demographics
NPI:1255873675
Name:SACRED LOTUS HEALING
Entity type:Organization
Organization Name:SACRED LOTUS HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LEEANN
Authorized Official - Last Name:BREWSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CAP, CYT, BSPE
Authorized Official - Phone:907-575-7411
Mailing Address - Street 1:PO BOX 200579
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99520-0579
Mailing Address - Country:US
Mailing Address - Phone:907-575-7411
Mailing Address - Fax:
Practice Address - Street 1:5313 ARCTIC BLVD STE 200B
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1111
Practice Address - Country:US
Practice Address - Phone:907-575-7411
Practice Address - Fax:844-965-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1003072225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty