Healthcare Provider Details

I. General information

NPI: 1053226480
Provider Name (Legal Business Name): CHRISTOPHER TRAVIS OLLUNFE LIGHTFOOT-TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1917 ABBOTT RD STE 200
ANCHORAGE AK
99507-3449
US

IV. Provider business mailing address

1917 ABBOTT RD STE 200
ANCHORAGE AK
99507-3449
US

V. Phone/Fax

Practice location:
  • Phone: 907-279-4266
  • Fax: 907-279-4272
Mailing address:
  • Phone: 907-279-4266
  • Fax: 907-279-4272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number255790
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: