Healthcare Provider Details

I. General information

NPI: 1962657056
Provider Name (Legal Business Name): ALASKA PEDIATRIC PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 LAUREL ST SUITE 102
ANCHORAGE AK
99508-5338
US

IV. Provider business mailing address

10201 JACKPOT BAY CIR
ANCHORAGE AK
99515-2411
US

V. Phone/Fax

Practice location:
  • Phone: 907-727-5624
  • Fax: 907-929-4839
Mailing address:
  • Phone: 907-727-5624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1808
License Number StateAK

VII. Legacy identifiers

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

# 1
Identifier23391
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer
# 2
Identifier2339
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name: JESSICA LEIGH HUEY
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 907-727-5624