Provider Demographics
NPI:1306181821
Name:JEFFREY C TROTTER
Entity Type:Organization
Organization Name:JEFFREY C TROTTER
Other - Org Name:FRONTIER THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:907-646-9774
Mailing Address - Street 1:2421 E TUDOR RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1166
Mailing Address - Country:US
Mailing Address - Phone:907-646-9774
Mailing Address - Fax:907-646-9775
Practice Address - Street 1:2421 E TUDOR RD STE 103
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1166
Practice Address - Country:US
Practice Address - Phone:907-646-9774
Practice Address - Fax:907-646-9775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK981394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1581631Medicaid