Provider Demographics
NPI:1124499231
Name:LIFETOUCH MASSAGE AND WELLNESS, LTD
Entity type:Organization
Organization Name:LIFETOUCH MASSAGE AND WELLNESS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CDT
Authorized Official - Phone:907-727-2596
Mailing Address - Street 1:1700 E BOGARD RD
Mailing Address - Street 2:SUITE 200 A
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6563
Mailing Address - Country:US
Mailing Address - Phone:907-727-2596
Mailing Address - Fax:
Practice Address - Street 1:5620 E BEAVER AVE
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-4633
Practice Address - Country:US
Practice Address - Phone:907-727-2596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101861225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty