Healthcare Provider Details

I. General information

NPI: 1932244068
Provider Name (Legal Business Name): ALASKA AQUATIC THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35932 KENAI SPUR HWY
SOLDOTNA AK
99669-7103
US

IV. Provider business mailing address

PO BOX 3313
SOLDOTNA AK
99669-3313
US

V. Phone/Fax

Practice location:
  • Phone: 907-398-0411
  • Fax: 866-502-3411
Mailing address:
  • Phone: 907-283-7946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY KAY GARDNER
Title or Position: OWNER
Credential: DPT
Phone: 190-739-8041