Provider Demographics
NPI:1598007205
Name:NORTHERN SEAWOLF HOLDINGS
Entity Type:Organization
Organization Name:NORTHERN SEAWOLF HOLDINGS
Other - Org Name:SEAWOLF PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KORRE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:PIEPER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:907-677-9653
Mailing Address - Street 1:12201 INDUSTRY WAY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-4316
Mailing Address - Country:US
Mailing Address - Phone:907-677-9653
Mailing Address - Fax:
Practice Address - Street 1:12201 INDUSTRY WAY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-4316
Practice Address - Country:US
Practice Address - Phone:907-677-9653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1767261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy