Provider Demographics
NPI:1508528472
Name:EMPOWER PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:EMPOWER PHYSICAL THERAPY, LLC
Other - Org Name:EMPOWER PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PARTNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:POLLARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:907-373-9462
Mailing Address - Street 1:3765 E BLUE LUPINE DR STE E
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8417
Mailing Address - Country:US
Mailing Address - Phone:907-373-9462
Mailing Address - Fax:907-373-9464
Practice Address - Street 1:3765 E BLUE LUPINE DR STE E
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8417
Practice Address - Country:US
Practice Address - Phone:907-373-9462
Practice Address - Fax:907-373-9464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-08
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty