Provider Demographics
NPI:1417702440
Name:TEAYOUMEAK, MICHELLE MADELEINE (LMT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MADELEINE
Last Name:TEAYOUMEAK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:MADELEINE
Other - Last Name:TEAYOUMEAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:201 E 16TH AVE APT 125
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-5262
Mailing Address - Country:US
Mailing Address - Phone:907-802-8477
Mailing Address - Fax:
Practice Address - Street 1:2665 E TUDOR RD STE 201
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1144
Practice Address - Country:US
Practice Address - Phone:907-222-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK210805225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty