Provider Demographics
NPI:1497805949
Name:ACTION REHAB, LLC
Entity Type:Organization
Organization Name:ACTION REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-790-4880
Mailing Address - Street 1:8800 GLACIER HWY STE 236
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8080
Mailing Address - Country:US
Mailing Address - Phone:907-790-4880
Mailing Address - Fax:907-790-4881
Practice Address - Street 1:8800 GLACIER HWY STE 236
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8080
Practice Address - Country:US
Practice Address - Phone:907-790-4880
Practice Address - Fax:907-790-4881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK843225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKTC7515Medicaid
AKTC7515Medicaid