Provider Demographics
NPI:1811693328
Name:STATON, WHITNEY BROOKE (LMT)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:BROOKE
Last Name:STATON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:STATON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:2225 ARCTIC BLVD APT 114
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-1931
Mailing Address - Country:US
Mailing Address - Phone:907-727-2236
Mailing Address - Fax:
Practice Address - Street 1:1350 W NORTHERN LIGHTS BLVD # C
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3614
Practice Address - Country:US
Practice Address - Phone:907-334-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK203989225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist