Provider Demographics
NPI:1083967822
Name:ALASKA THERAPEUTIC & AQUATIC SPECIALISTS LLC
Entity Type:Organization
Organization Name:ALASKA THERAPEUTIC & AQUATIC SPECIALISTS LLC
Other - Org Name:ATAS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:M
Authorized Official - Last Name:TARDY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:907-310-2290
Mailing Address - Street 1:4800 RIDGE TOP CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3793
Mailing Address - Country:US
Mailing Address - Phone:907-310-2290
Mailing Address - Fax:907-522-5144
Practice Address - Street 1:4800 RIDGE TOP CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3793
Practice Address - Country:US
Practice Address - Phone:907-310-2290
Practice Address - Fax:907-522-5144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK737261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy