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NPI Code Detail

MEDICARE: ASPEN PHYSICAL THERAPY PC

MEDICARE: ASPEN PHYSICAL THERAPY PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist695AK

General Provider Information

NPI Number : 1174729123
Entity Type Code : Organization
Provider Name (Legal Business Name) : ASPEN PHYSICAL THERAPY PC
Provider Business Mailing Address
First Line : PO BOX 3763
Second Line :
City : SOLDOTNA
State : AK
Zip : 99669-3763
Country : US
Telephone Number : 907-262-2596
Fax Number :
Provider Business Practice Location Address
First Line : 221 W. MARYDALE AVE
Second Line :
City : SOLDOTNA
State : AK
Zip : 99669-7540
Country : US
Telephone Number : 907-262-2596
Fax Number :
Authorized Official
Title or Position : OWNER
Name : THOMAS T WELLS JR.
Credential : P.T.
Telephone Number : 907-262-2596
Provider Enumeration Date : 06/26/2007
Last Update Date : 12/21/2007

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Directions to “ASPEN PHYSICAL THERAPY PC ” Practice Location

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