Healthcare Provider Details

I. General information

NPI: 1205064136
Provider Name (Legal Business Name): MARY H POMEROY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 LAUREL ST SUITE 100
ANCHORAGE AK
99508-5364
US

IV. Provider business mailing address

4325 LAUREL ST SUITE 100
ANCHORAGE AK
99508-5364
US

V. Phone/Fax

Practice location:
  • Phone: 907-376-8280
  • Fax: 907-376-0293
Mailing address:
  • Phone: 907-376-8280
  • Fax: 907-376-0293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number72248
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOSEPH E BEATY
Title or Position: BILLING AGENT
Credential:
Phone: 907-770-2301