Healthcare Provider Details

I. General information

NPI: 1710528088
Provider Name (Legal Business Name): TESSA MERRITT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 E PALMER WASILLA HWY
WASILLA AK
99654-7234
US

IV. Provider business mailing address

1917 ABBOTT RD STE 200
ANCHORAGE AK
99507-3449
US

V. Phone/Fax

Practice location:
  • Phone: 907-743-8270
  • Fax: 907-743-8271
Mailing address:
  • Phone: 907-376-8590
  • Fax: 907-743-8270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03250
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number208223
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: