Provider Demographics
NPI:1003438508
Name:ENC PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ENC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZA
Authorized Official - Middle Name:NICOLAS
Authorized Official - Last Name:CAGUIOA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:907-545-2774
Mailing Address - Street 1:PO BOX 2352
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-2352
Mailing Address - Country:US
Mailing Address - Phone:907-545-2774
Mailing Address - Fax:
Practice Address - Street 1:223 BLACKBERRY STREET
Practice Address - Street 2:UNIT A
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559
Practice Address - Country:US
Practice Address - Phone:907-545-2774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty