Provider Demographics
NPI:1134313661
Name:PHYSICAL THERAPY PLACE, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY PLACE, LLC
Other - Org Name:THE PHYSICAL THERAPY PLACE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PIRAINO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:907-569-5557
Mailing Address - Street 1:PO BOX 240453
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524-0453
Mailing Address - Country:US
Mailing Address - Phone:907-569-5557
Mailing Address - Fax:907-569-5562
Practice Address - Street 1:4050 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5212
Practice Address - Country:US
Practice Address - Phone:907-569-5557
Practice Address - Fax:907-569-5562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT2258Medicaid
AKPT8441Medicaid
AK151231Medicare PIN