Healthcare Provider Details

I. General information

NPI: 1205545498
Provider Name (Legal Business Name): LIGHT PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22424 BIRCHWOOD LOOP RD
CHUGIAK AK
99567-6476
US

IV. Provider business mailing address

6442 LONE TREE CIR
ANCHORAGE AK
99507-6940
US

V. Phone/Fax

Practice location:
  • Phone: 907-727-4950
  • Fax:
Mailing address:
  • Phone: 907-727-4950
  • 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: JULIE LIGHT
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 907-727-4950