Provider Demographics
NPI:1629404686
Name:PRATER, DAVID ELIJAH (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ELIJAH
Last Name:PRATER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 S CHUGACH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6665
Mailing Address - Country:US
Mailing Address - Phone:907-746-4373
Mailing Address - Fax:907-746-4376
Practice Address - Street 1:809 S CHUGACH ST STE 1
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6665
Practice Address - Country:US
Practice Address - Phone:907-746-4373
Practice Address - Fax:907-746-4376
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist