Provider Demographics
NPI:1386059079
Name:WHOLISTIC MASSAGE LLC
Entity type:Organization
Organization Name:WHOLISTIC MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINIC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:PEARCH
Authorized Official - Suffix:
Authorized Official - Credentials:BA, ACMT, LMT
Authorized Official - Phone:907-312-9578
Mailing Address - Street 1:700 W 58TH AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1633
Mailing Address - Country:US
Mailing Address - Phone:907-312-9578
Mailing Address - Fax:
Practice Address - Street 1:700 W 58TH AVE
Practice Address - Street 2:UNIT A
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1633
Practice Address - Country:US
Practice Address - Phone:907-312-9578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-22
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1004320261QR0400X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty