Healthcare Provider Details

I. General information

NPI: 1770791485
Provider Name (Legal Business Name): DOUGLAS JAMES WESTPHAL PT,MS, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 BARTLETT ST
HOMER AK
99603-7005
US

IV. Provider business mailing address

PO BOX 308
HOMER AK
99603-0308
US

V. Phone/Fax

Practice location:
  • Phone: 907-235-0370
  • Fax:
Mailing address:
  • Phone: 907-235-3961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number00491
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: