Healthcare Provider Details

I. General information

NPI: 1295913135
Provider Name (Legal Business Name): JAMMIN' SALMONS' PHYSICAL & NUTRITIONAL THERAPIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 CROSSMAN RD
FAIRBANKS AK
99712-1413
US

IV. Provider business mailing address

828 CROSSMAN RD
FAIRBANKS AK
99712-1413
US

V. Phone/Fax

Practice location:
  • Phone: 907-457-6688
  • Fax: 907-452-6488
Mailing address:
  • Phone: 907-457-6688
  • Fax: 907-452-6488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CINDY J SALMON
Title or Position: VICE PRESIDENT
Credential: R.D.
Phone: 907-457-6688