Provider Demographics
NPI:1053769612
Name:LETONEK, REGINA M (LMT)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:M
Last Name:LETONEK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71044
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-1044
Mailing Address - Country:US
Mailing Address - Phone:907-888-3415
Mailing Address - Fax:
Practice Address - Street 1:1303 BAINBRIDGE BLVD # 9
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-2734
Practice Address - Country:US
Practice Address - Phone:907-888-3415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK108223225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist