Provider Demographics
NPI:1770130023
Name:HOWARD, RENEE JACQUELINE (LMT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:JACQUELINE
Last Name:HOWARD
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 1:8100 N LUCKY SHOT LN
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-8073
Mailing Address - Country:US
Mailing Address - Phone:907-982-0264
Mailing Address - Fax:
Practice Address - Street 1:1734 PROSPECT DR
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-9964
Practice Address - Country:US
Practice Address - Phone:907-746-7842
Practice Address - Fax:907-745-7883
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101369225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist