Healthcare Provider Details

I. General information

NPI: 1528199254
Provider Name (Legal Business Name): SITKA PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 KATLIAN ST STE E
SITKA AK
99835-7359
US

IV. Provider business mailing address

700 KATLIAN ST STE E
SITKA AK
99835-7359
US

V. Phone/Fax

Practice location:
  • Phone: 907-747-5861
  • Fax: 907-747-5415
Mailing address:
  • Phone: 907-747-5861
  • Fax: 907-747-5415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number306628
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number306628
License Number StateAK

VIII. Authorized Official

Name: ERIC SPECK
Title or Position: PHYSICAL THERAPIST
Credential: MSPT
Phone: 907-747-5861