Healthcare Provider Details

I. General information

NPI: 1114391398
Provider Name (Legal Business Name): ROSHAN KUMAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 AIRPORT HEIGHTS DR STE 170
ANCHORAGE AK
99508-2986
US

IV. Provider business mailing address

1200 AIRPORT HEIGHTS DR STE 170
ANCHORAGE AK
99508-2986
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-2118
  • Fax: 907-562-2128
Mailing address:
  • Phone: 907-562-2118
  • Fax: 907-562-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number208599
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: