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Individual

MR. TATE LEVI DE ATLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CMT

Contact information

Practice address
814 E REZANOF DR, KODIAK, AK 99615-6598
(907) 487-9798
Mailing address
1897 L ST LOT 10, KODIAK, AK 99615-6902
(317) 689-9894

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
236925
AK

Other

Enumeration date
03/28/2025
Last updated
03/28/2025
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