Healthcare Provider Details

I. General information

NPI: 1700074382
Provider Name (Legal Business Name): THERAPIST CENTRAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12201 INDUSTRY WAY STE 4
ANCHORAGE AK
99515-4316
US

IV. Provider business mailing address

12201 INDUSTRY WAY STE 4
ANCHORAGE AK
99515-4316
US

V. Phone/Fax

Practice location:
  • Phone: 907-677-9653
  • Fax: 907-677-9657
Mailing address:
  • Phone: 907-677-9653
  • Fax: 907-677-9657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2030
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. KORRE LEIGH PIEPER
Title or Position: PRESIDENT
Credential: PT
Phone: 907-677-9653