Healthcare Provider Details

I. General information

NPI: 1891383378
Provider Name (Legal Business Name): FRONT LINE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2021
Last Update Date: 01/09/2021
Certification Date: 01/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5790 W APPALACHIAN AVE
WASILLA AK
99623-0333
US

IV. Provider business mailing address

23756 HILLTOP DR
CHUGIAK AK
99567-6267
US

V. Phone/Fax

Practice location:
  • Phone: 503-970-0468
  • Fax:
Mailing address:
  • Phone:
  • 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: CASEY BUCKLAND
Title or Position: OWNER CEO
Credential:
Phone: 503-970-0468