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General NPI Number Information
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NPI Number | 1609421502
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Entity Type | Organization
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Legal Business Name | FORTITUDE, INC
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Dates
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Enumeration Date | 08/07/2019
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 43900 KENAI SPUR HWY UNIT C
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City | KENAI
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State | AK
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Zip | 99611-9708
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Country | US
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Telephone | 907-283-3340
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Fax | 907-283-3349
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Provider Business Mailing Address
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Address Line | 49066 HEIGHTS LN
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City | KENAI
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State | AK
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Zip | 99611-6112
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Country | US
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Telephone | 907-290-9973
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONALD TAYLOR SMITH STATON
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Credential | DPT
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Telephone | 907-283-3340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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