Individual provider · Type 1 NPI

Gordon Jay Wallis, LMT.

Specialist · Anchorage, AK

NPI number 1548711005 Active

Practice location

142 W 5th Ave
Anchorage, AK 99501-2522

Call (907) 258-1122 Map

Mailing address

1020 W 12th Ave, Suite 714
Anchorage, AK 99501-4577

Specialties and licenses

TaxonomyCodeLicense
Specialist Primary 174400000X101469 (AK)

Specialist: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

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About NPI 1548711005

Gordon Jay Wallis, LMT.'s National Provider Identifier is 1548711005, issued on Oct 19, 2016. The primary taxonomy on file is Specialist (174400000X), and the practice location is in Anchorage, AK. The record was last updated on Oct 19, 2016.