Provider Demographics
NPI:1780268797
Name:CHRISTIAN, KATHERYNE (LMT)
Entity type:Individual
Prefix:
First Name:KATHERYNE
Middle Name:
Last Name:CHRISTIAN
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 1:12812 OLD GLENN HWY STE A8
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7003
Mailing Address - Country:US
Mailing Address - Phone:907-696-8020
Mailing Address - Fax:907-696-8021
Practice Address - Street 1:12812 OLD GLENN HWY STE A8
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7003
Practice Address - Country:US
Practice Address - Phone:907-696-8020
Practice Address - Fax:907-696-8021
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK169012225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK169012OtherSTATE OF ALASKA MASSAGE THERAPIST LICENSE