Healthcare Provider Details

I. General information

NPI: 1780593574
Provider Name (Legal Business Name): BIG LAKE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12900 W CREEK FRONTAGE RD
BIG LAKE AK
99623-4880
US

IV. Provider business mailing address

PO BOX 520834
BIG LAKE AK
99652-0834
US

V. Phone/Fax

Practice location:
  • Phone: 913-515-6486
  • Fax:
Mailing address:
  • Phone: 913-515-6486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SARAH HANVY
Title or Position: OWNER
Credential: DPT
Phone: 913-515-6486