Provider Demographics
NPI:1053876243
Name:READ, LARRY (MASSAGE THERAPUST)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:READ
Suffix:
Gender:M
Credentials:MASSAGE THERAPUST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8061 PIONEER DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4745
Mailing Address - Country:US
Mailing Address - Phone:907-529-1924
Mailing Address - Fax:
Practice Address - Street 1:8061 PIONEER DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4745
Practice Address - Country:US
Practice Address - Phone:907-529-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK108228225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALASKAOther108228