Provider Demographics
NPI:1154195113
Name:MYO MASSAGE STUDIO ALASKA
Entity type:Organization
Organization Name:MYO MASSAGE STUDIO ALASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLENT MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:907-953-7874
Mailing Address - Street 1:53140 N SHORE CT
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-9642
Mailing Address - Country:US
Mailing Address - Phone:907-953-7874
Mailing Address - Fax:
Practice Address - Street 1:43335 KALIFORNSKY BEACH RD STE 16H
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8250
Practice Address - Country:US
Practice Address - Phone:907-953-7874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty