Provider Demographics
NPI:1548773849
Name:MICHALSKI, LESLIE K (LMT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:K
Last Name:MICHALSKI
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 1:1036 W 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-1738
Mailing Address - Country:US
Mailing Address - Phone:907-562-2273
Mailing Address - Fax:800-782-4191
Practice Address - Street 1:510 W TUDOR RD STE 9
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-562-2273
Practice Address - Fax:800-782-4191
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK125764225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK125764OtherLMT LICENSE