Healthcare Provider Details

I. General information

NPI: 1538850656
Provider Name (Legal Business Name): REALIFE PHYSICAL THERAPY & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4524 S MAINSAIL AVE BLDG 2
WASILLA AK
99623-0352
US

IV. Provider business mailing address

7362 W PARKS HWY # 422
WASILLA AK
99623-9300
US

V. Phone/Fax

Practice location:
  • Phone: 844-949-9075
  • Fax: 844-907-5075
Mailing address:
  • Phone: 844-949-9075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: TRISHA MARIE MAGEE
Title or Position: PHYSICAL THERAPIST, OWNER
Credential: PT
Phone: 844-949-9075