Provider Demographics
NPI:1477002616
Name:TRANSFORM PHYSICAL THERAPY
Entity Type:Organization
Organization Name:TRANSFORM PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:907-276-0099
Mailing Address - Street 1:3310 ARCTIC BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4576
Mailing Address - Country:US
Mailing Address - Phone:907-276-0099
Mailing Address - Fax:
Practice Address - Street 1:3310 ARCTIC BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4576
Practice Address - Country:US
Practice Address - Phone:907-276-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5162251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty