Provider Demographics
NPI:1972043537
Name:ADVANCED MASSAGE THERAPY
Entity type:Organization
Organization Name:ADVANCED MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-888-4060
Mailing Address - Street 1:2513 DAVIS RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5200
Mailing Address - Country:US
Mailing Address - Phone:907-888-4060
Mailing Address - Fax:
Practice Address - Street 1:600 3RD ST STE 200
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3569
Practice Address - Country:US
Practice Address - Phone:907-888-4060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK104398225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty