Provider Demographics
NPI:1144993569
Name:HOMER MASSAGE THERAPY
Entity type:Organization
Organization Name:HOMER MASSAGE THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:907-299-8284
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:ANCHOR POINT
Mailing Address - State:AK
Mailing Address - Zip Code:99556-0407
Mailing Address - Country:US
Mailing Address - Phone:907-299-8284
Mailing Address - Fax:206-312-3201
Practice Address - Street 1:1104 OCEAN DR UNIT A
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7919
Practice Address - Country:US
Practice Address - Phone:907-299-8284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK45-2493925Medicaid