Provider Demographics
NPI:1376503888
Name:MORMILE, DONALD A (PT)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:A
Last Name:MORMILE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 201773
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99520-1773
Mailing Address - Country:US
Mailing Address - Phone:907-770-2380
Mailing Address - Fax:907-770-2390
Practice Address - Street 1:1600 A ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501
Practice Address - Country:US
Practice Address - Phone:907-561-1800
Practice Address - Fax:907-562-4705
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPTO285Medicaid
209366OtherPHP GENERIC ID
A3024OtherBLUE CROSS
AK00526Medicare ID - Type Unspecified
AKPTO285Medicaid