Healthcare Provider Details

I. General information

NPI: 1972790061
Provider Name (Legal Business Name): REBECCA BLANSETT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 12/23/2022
Certification Date: 11/14/2022
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 TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPA3126
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPHYA2706
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: