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General NPI Number Information
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NPI Number | 1831123165
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Entity Type | Organization
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Legal Business Name | WILLOW PHYSICAL THERAPY, LIMITED
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 544 4TH AVE # 102
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City | FAIRBANKS
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State | AK
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Zip | 99701-4714
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Country | US
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Telephone | 907-456-5990
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Fax | 907-374-8023
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Provider Business Mailing Address
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Address Line | 544 4TH AVE STE 102
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City | FAIRBANKS
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State | AK
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Zip | 99701-4714
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Country | US
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Telephone | 907-456-5990
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Fax | 907-374-8023
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Authorized Official
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Title or Position | OWNER
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Name | AISHA WILBUR
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Credential |
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Telephone | 907-456-5990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 183875
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License Number State | AK
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