Individual
LISA M GOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
35021 KENAI SPUR HWY STE C, SOLDOTNA, AK 99669-7670
(415) 770-0358
Mailing address
PO BOX 1673, KENAI, AK 99611-1673
(907) 953-1101
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
176525
AK
Other
Enumeration date
02/23/2022
Last updated
07/08/2023
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