Healthcare Provider Details

I. General information

NPI: 1932266228
Provider Name (Legal Business Name): DENALI MESA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 E DOWLING RD STE 26
ANCHORAGE AK
99518-1424
US

IV. Provider business mailing address

907 E DOWLING RD STE 26
ANCHORAGE AK
99518-1427
US

V. Phone/Fax

Practice location:
  • Phone: 907-258-8618
  • Fax: 907-563-9291
Mailing address:
  • Phone: 907-258-8618
  • Fax: 907-563-9291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: PATRICK KINNEBREW
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 907-258-8618