Elizabeth Marie Clark, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

166299 Issued in AK

Practice address

1212 W Mystery Ave Ste B
Wasilla, AK 99654-6335

Phone

(907) 521-8002

NPI assigned

Feb 10, 2021

Last updated

Feb 10, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Charlie Clark Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Alaska Massage Studio LLC

  dba Alaska Massage Studio

  • Massage Therapist
  • Wasilla, AK
  • NPI 1083441554
  NPD
• Alaska Massage Studio LLC

  dba Alaska Massage Studio

  • Massage Therapist
  • Wasilla, AK
  • NPI 1447798996
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612915200000",
    "number": "1720670698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 W MYSTERY AVE STE B",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996546335",
            "telephone_number": "907-521-8002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 W MYSTERY AVE STE B",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996546335",
            "telephone_number": "907-521-8002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ELIZABETH",
        "middle_name": "MARIE",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-10",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "AK",
            "license": "166299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHARLIE",
            "last_name": "CLARK",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Mark Clafshenkel, RPH
• Richard Clampitt
• Adam Dawson Clark
• Christy Clark, LMT
• Devan Clark, LMT
• Zackariah Clark
• Uriah Josiah Clarkson, RPH
• Classic Eyeware
• Matthew R Clayton
• Karen Rebecca Clement, PA

• Massage Therapist in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Massage Therapist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.