Provider Demographics
NPI:1114960739
Name:PASEK, JAMES RAYMOND (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RAYMOND
Last Name:PASEK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-7699
Mailing Address - Country:US
Mailing Address - Phone:907-488-4978
Mailing Address - Fax:907-488-4976
Practice Address - Street 1:506 GAFFNEY STREET
Practice Address - Street 2:STE 300
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4980
Practice Address - Country:US
Practice Address - Phone:907-374-0992
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1181225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT7158Medicaid
AKPT7158Medicaid