Healthcare Provider Details

I. General information

NPI: 1952145989
Provider Name (Legal Business Name): KASSANDRA SARDAKOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11421 OLD GLENN HWY STE 101
EAGLE RIVER AK
99577-7783
US

IV. Provider business mailing address

11421 OLD GLENN HWY STE 101
EAGLE RIVER AK
99577-7783
US

V. Phone/Fax

Practice location:
  • Phone: 907-622-2500
  • Fax: 855-278-1698
Mailing address:
  • Phone: 907-622-2500
  • Fax: 855-278-1698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501303790
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: