Provider Demographics
NPI:1740419548
Name:HEALTHWISE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:HEALTHWISE PHYSICAL THERAPY INC
Other - Org Name:HEALTHWISE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-622-2502
Mailing Address - Street 1:11421 OLD GLENN HWY
Mailing Address - Street 2:STE 100
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7729
Mailing Address - Country:US
Mailing Address - Phone:907-694-2273
Mailing Address - Fax:907-694-2289
Practice Address - Street 1:11421 OLD GLENN HWY
Practice Address - Street 2:STE 100
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7729
Practice Address - Country:US
Practice Address - Phone:907-694-2273
Practice Address - Fax:907-694-2289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1527225100000X
AK1290225100000X
AK337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT11942Medicaid
AKPT2491Medicaid
AKPT2792Medicaid