MEDICARE: SIMAR PHYSICAL THERAPY SERVICES, LLC

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
1	261QP2000X	Physical Therapy Clinic/Center	PT1054	AK

General Provider Information

NPI Number	:	1821254814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMAR PHYSICAL THERAPY SERVICES, LLC

Provider Business Mailing Address
First Line	:	22621 NORTHWOODS DR
Second Line	:
City	:	CHUGIAK
State	:	AK
Zip	:	99567-5459
Country	:	US
Telephone Number	:	907-350-6642
Fax Number	:	907-746-7302

Provider Business Practice Location Address
First Line	:	7335 E PALMER-WASILLA HWY
Second Line	:	SUITE 1C
City	:	PALMER
State	:	AK
Zip	:	99645
Country	:	US
Telephone Number	:	907-746-7300
Fax Number	:	907-746-7302

Authorized Official
Title or Position	:	OWNER, PHYSICAL THERAPIST
Name	:	TIMOTHY LANDON
Credential	:	PT
Telephone Number	:	907-746-7300

Provider Enumeration Date	:	07/30/2008
Last Update Date	:	07/30/2008

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