Provider Demographics
NPI:1558648030
Name:HOOD, SHASTA (DPT)
Entity Type:Individual
Prefix:DR
First Name:SHASTA
Middle Name:
Last Name:HOOD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8237 SAND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-4013
Mailing Address - Country:US
Mailing Address - Phone:406-291-1860
Mailing Address - Fax:
Practice Address - Street 1:17101 SNOWMOBILE LN STE 202
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7043
Practice Address - Country:US
Practice Address - Phone:907-694-8085
Practice Address - Fax:907-694-8526
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2368225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist