Healthcare Provider Details

I. General information

NPI: 1669589396
Provider Name (Legal Business Name): JOEL EVERARD PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 E TUDOR RD
ANCHORAGE AK
99507-1136
US

IV. Provider business mailing address

2704 E TUDOR RD
ANCHORAGE AK
99507-1136
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-5006
  • Fax: 907-562-2398
Mailing address:
  • Phone: 907-561-5006
  • Fax: 907-562-2398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1665
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1665
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: