Provider Demographics
NPI: | 1497538474 |
---|---|
Name: | NORTHERN EDGE PHYSICAL THERAPY LIMITED PARTNERSHIP |
Entity Type: | Organization |
Organization Name: | NORTHERN EDGE PHYSICAL THERAPY LIMITED PARTNERSHIP |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EVP |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RICHARD |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BINSTEIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 713-297-7000 |
Mailing Address - Street 1: | 984 N MERIDIAN PL |
Mailing Address - Street 2: | |
Mailing Address - City: | WASILLA |
Mailing Address - State: | AK |
Mailing Address - Zip Code: | 99654-7215 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 907-631-4029 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 984 N MERIDIAN PL |
Practice Address - Street 2: | |
Practice Address - City: | WASILLA |
Practice Address - State: | AK |
Practice Address - Zip Code: | 99654-7215 |
Practice Address - Country: | US |
Practice Address - Phone: | 907-631-4029 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-08-15 |
Last Update Date: | 2023-08-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty |