{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ARCTIC THERAPY & REHAB BETHEL",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "1150 S COLONY WAY STE 3",
"SecondLineMailingAddress": "PMB 226",
"MailingAddressCityName": "PALMER",
"MailingAddressStateName": "AK",
"MailingAddressPostalCode": "99645-6967",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "907-543-7601",
"MailingAddressFaxNumber": "907-543-7018",
"FirstLinePracticeLocationAddress": "107 ALEX HATLEY DR, STE B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BETHEL",
"PracticeLocationAddressStateName": "AK",
"PracticeLocationAddressPostalCode": "99559-3466",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "907-543-7600",
"PracticeLocationAddressFaxNumber": "877-803-8297",
"EnumerationDate": "07/09/2015",
"LastUpdateDate": "05/13/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CAMPBELL",
"AuthorizedOfficialFirstName": "WALTER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "907-250-7246",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "2841",
"LicenseNumberStateCode": "AK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}