Provider Demographics
NPI:1811627862
Name:BLANN, KASEY RIVER (LMT)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:RIVER
Last Name:BLANN
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 1:2011 ABBOTT RD STE C
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3400
Mailing Address - Country:US
Mailing Address - Phone:907-531-9342
Mailing Address - Fax:
Practice Address - Street 1:2011 ABBOTT RD STE C
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3400
Practice Address - Country:US
Practice Address - Phone:907-531-9342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK181326225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist