Provider Demographics
NPI:1225447915
Name:WASSON, ALATI (DPT)
Entity Type:Individual
Prefix:
First Name:ALATI
Middle Name:
Last Name:WASSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALATI
Other - Middle Name:
Other - Last Name:GAGNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4201 TUDOR CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5914
Mailing Address - Country:US
Mailing Address - Phone:907-729-6692
Mailing Address - Fax:
Practice Address - Street 1:4100 LAKE OTIS PKWY STE 106
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5230
Practice Address - Country:US
Practice Address - Phone:907-563-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
AK2813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist