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NPI Code Detail

MEDICARE: HOMER PHYSICAL THERAPY, LLC

MEDICARE: HOMER PHYSICAL THERAPY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251X0800XOrthopedic Physical Therapist1134AK

General Provider Information

NPI Number : 1750499224
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOMER PHYSICAL THERAPY, LLC
Provider Business Mailing Address
First Line : 4141 PENNOCK ST
Second Line :
City : HOMER
State : AK
Zip : 99603-7223
Country : US
Telephone Number : 907-235-3410
Fax Number : 907-235-3417
Provider Business Practice Location Address
First Line : 4141 PENNOCK ST
Second Line :
City : HOMER
State : AK
Zip : 99603-7223
Country : US
Telephone Number : 907-235-3410
Fax Number : 907-235-3417
Authorized Official
Title or Position : OWNER
Name : SALLIE W REDISKE
Credential : MPT
Telephone Number : 907-235-3410
Provider Enumeration Date : 08/26/2006
Last Update Date : 03/22/2013

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Directions to “HOMER PHYSICAL THERAPY, LLC ” Practice Location

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