Healthcare Provider Details

I. General information

NPI: 1225878788
Provider Name (Legal Business Name): JESSICA LYNN ANGOWSKI PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3765 E BLUE LUPINE DR STE E
WASILLA AK
99654-8417
US

IV. Provider business mailing address

3765 E BLUE LUPINE DR STE E
WASILLA AK
99654-8417
US

V. Phone/Fax

Practice location:
  • Phone: 907-373-9462
  • Fax: 907-373-9464
Mailing address:
  • Phone: 907-373-9462
  • Fax: 907-373-9464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02253100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP051485T
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: