Provider Demographics
NPI:1578736906
Name:EVERARD PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:EVERARD PHYSICAL THERAPY, LLC
Other - Org Name:SEETHALER PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/MANAGER, PT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:907-561-5006
Mailing Address - Street 1:2704 E TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1136
Mailing Address - Country:US
Mailing Address - Phone:907-561-5006
Mailing Address - Fax:907-562-2398
Practice Address - Street 1:2704 E TUDOR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1136
Practice Address - Country:US
Practice Address - Phone:907-561-5006
Practice Address - Fax:907-562-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK911981261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy