Individual
SAMANTHA LANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
101890
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101890
ALASKA STATE MASSAGE THERAPY LICSENSE
AK
Enumeration date
12/12/2016
Last updated
12/12/2016
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