MEDICARE: DAVID DISSELBRETT MSPT, JSCC

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	225100000X	Physical Therapist	AK1191	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881864692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID DISSELBRETT MSPT, JSCC

Provider Business Mailing Address
First Line	:	5185 W 80TH AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-4114
Country	:	US
Telephone Number	:	907-351-2052
Fax Number	:

Provider Business Practice Location Address
First Line	:	5185 W 80TH AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-4114
Country	:	US
Telephone Number	:	907-351-2052
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	03/17/2018

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