Provider Demographics
NPI:1801070982
Name:DUNCAN, SANDRA L (CMT, MLD, CDT)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:L
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:CMT, MLD, CDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3091
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-3091
Mailing Address - Country:US
Mailing Address - Phone:907-354-0453
Mailing Address - Fax:
Practice Address - Street 1:281 N. MAIN STREET
Practice Address - Street 2:C/O ALASKA MASSAGE CENTER SUITE 101B
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-354-0453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK709229225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist