Provider Demographics
NPI:1780851998
Name:DENALI MESA CORPORATION
Entity Type:Organization
Organization Name:DENALI MESA CORPORATION
Other - Org Name:FRONTIER THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KINNEBREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-258-8618
Mailing Address - Street 1:907 E DOWLING RD STE 26
Mailing Address - Street 2:ANCHORAGE
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1427
Mailing Address - Country:US
Mailing Address - Phone:907-258-8618
Mailing Address - Fax:907-563-9291
Practice Address - Street 1:2421 E TUDOR RD
Practice Address - Street 2:STE 103
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1128
Practice Address - Country:US
Practice Address - Phone:907-646-9774
Practice Address - Fax:907-646-9775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK193978501OtherU.S. DEPARTMENT OF LABOR
AKPT95101Medicaid
AKPT1442Medicaid