Individual
MISS STACE LEE ELIZABETH MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
436 N MAIN ST, WASILLA, AK 99654-7018
(907) 376-8020
(907) 376-8017
Mailing address
PO BOX 876268, WASILLA, AK 99687-6268
(907) 775-3577
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
143308
AK
Other
Enumeration date
04/22/2019
Last updated
04/22/2019
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