Provider Demographics
NPI:1962217331
Name:BAUKNECHT, MARLA
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:BAUKNECHT
Suffix:
Gender:U
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6634 LAKE OTIS PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-2176
Mailing Address - Country:US
Mailing Address - Phone:907-522-3511
Mailing Address - Fax:907-522-8551
Practice Address - Street 1:6634 LAKE OTIS PKWY STE A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-2176
Practice Address - Country:US
Practice Address - Phone:907-522-3511
Practice Address - Fax:907-522-8551
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK218072225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty