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: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12032 BUSINESS BLVD STE A
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 Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

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