Jacob Miller
Individual provider Active NPI Massage Therapist · Wasilla, AK
NPI 1962859199 · NPPES record last updated May 17, 2016
Key facts
- NPI
- 1962859199
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 101977 (AK)
- Practice address
- 546 N Main St
Wasilla, AK 99654-7019 - Phone
- (907) 376-2600
- Fax
- (907) 376-2605
- NPI assigned
- May 17, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101977 | AK | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stanley Health Clinics PC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 101977 | AK | Yes |
Addresses
Primary practice location
546 N Main St
Wasilla, AK 99654-7019
Mailing address
546 N Main St
Wasilla, AK 99654-7019
Phone (907) 376-2600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101977 | Other | AK | STATE OCCUPATIONAL LICENSE |
Other providers in Wasilla, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.