Healthcare Provider Details

I. General information

NPI: 1679897599
Provider Name (Legal Business Name): MARIA WADE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12032 BUSINESS BLVD
EAGLE RIVER AK
99577-7725
US

IV. Provider business mailing address

PO BOX 672075
CHUGIAK AK
99567-2075
US

V. Phone/Fax

Practice location:
  • Phone: 907-921-7384
  • Fax: 844-605-1820
Mailing address:
  • Phone: 907-921-7384
  • Fax: 844-605-1820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2128
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: