Provider Demographics
NPI:1205364551
Name:SOUTHEAST ALASKA THERAPIES, LLC
Entity Type:Organization
Organization Name:SOUTHEAST ALASKA THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEORGHETTE
Authorized Official - Middle Name:O
Authorized Official - Last Name:WALES-PLANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-957-6940
Mailing Address - Street 1:9109 MENDENHALL MALL RD STE 5K
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9109 MENDENHALL MALL RD STE 5K
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7136
Practice Address - Country:US
Practice Address - Phone:907-957-6940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2288261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1518182062OtherNPI