Healthcare Provider Details

I. General information

NPI: 1609915347
Provider Name (Legal Business Name): SOUTH ANCHORAGE PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E DIMOND BLVD STE 16
ANCHORAGE AK
99515-1949
US

IV. Provider business mailing address

300 E DIMOND BLVD STE 16
ANCHORAGE AK
99515-1949
US

V. Phone/Fax

Practice location:
  • Phone: 907-868-8686
  • Fax: 907-868-3687
Mailing address:
  • Phone: 907-868-8686
  • Fax: 907-868-3687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number408692
License Number StateAK

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CHERYL K MYERS
Title or Position: PRESIDENT
Credential: DPT, DMT OCS
Phone: 907-868-8686