Healthcare Provider Details

I. General information

NPI: 1982828281
Provider Name (Legal Business Name): JAMES MICHAEL HALES PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E BOGARD RD
WASILLA AK
99654-7114
US

IV. Provider business mailing address

1001 E BOGARD RD
WASILLA AK
99654-7114
US

V. Phone/Fax

Practice location:
  • Phone: 907-373-7246
  • Fax: 907-376-9225
Mailing address:
  • Phone: 907-373-7246
  • Fax: 907-376-9225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1849
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: