Provider Demographics
NPI:1326586348
Name:NOR-ALASKA PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:NOR-ALASKA PHYSICAL THERAPY, LLC
Other - Org Name:EAGLE CENTER PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOERRE
Authorized Official - Middle Name:H
Authorized Official - Last Name:BREVIK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:907-696-5678
Mailing Address - Street 1:11470 BUSINESS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7780
Mailing Address - Country:US
Mailing Address - Phone:907-696-5678
Mailing Address - Fax:907-696-2248
Practice Address - Street 1:11470 BUSINESS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7780
Practice Address - Country:US
Practice Address - Phone:907-696-5678
Practice Address - Fax:907-696-2248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1048322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty