Healthcare Provider Details

I. General information

NPI: 1154901619
Provider Name (Legal Business Name): AMB PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9364 MORNINGSIDE LOOP APT 3
ANCHORAGE AK
99515-4282
US

IV. Provider business mailing address

9364 MORNINGSIDE LOOP APT 3
ANCHORAGE AK
99515-4282
US

V. Phone/Fax

Practice location:
  • Phone: 908-312-3265
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALANA MARIE BENCIVENGO
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 908-312-3265