Healthcare Provider Details

I. General information

NPI: 1205421047
Provider Name (Legal Business Name): THERAPEUTIC HEALTH AND HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22502 SAMBAR LOOP
CHUGIAK AK
99567-5377
US

IV. Provider business mailing address

22502 SAMBAR LOOP
CHUGIAK AK
99567-5377
US

V. Phone/Fax

Practice location:
  • Phone: 907-762-4663
  • Fax:
Mailing address:
  • Phone: 907-762-4663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. PHILIP JOSEPH BIANCO WHITE
Title or Position: OWNER/MEMBER
Credential: MOT
Phone: 503-888-8517