Provider Demographics
NPI:1801344577
Name:WHITMARSH, CEAN (LMT)
Entity type:Individual
Prefix:
First Name:CEAN
Middle Name:
Last Name:WHITMARSH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 OLD RICHARDSON HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-7802
Mailing Address - Country:US
Mailing Address - Phone:907-328-5965
Mailing Address - Fax:855-414-4818
Practice Address - Street 1:751 OLD RICHARDSON HWY STE 101
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7802
Practice Address - Country:US
Practice Address - Phone:907-328-5965
Practice Address - Fax:855-414-4818
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT123921225700000X
COMT.0015832225700000X
AK130033225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist