Provider Demographics
NPI:1790894806
Name:JUNEAU PHYSICAL THERAPY
Entity Type:Organization
Organization Name:JUNEAU PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOERANSSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:907-585-5951
Mailing Address - Street 1:641 W WILLOUGHBY AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1731
Mailing Address - Country:US
Mailing Address - Phone:907-586-5951
Mailing Address - Fax:907-586-8017
Practice Address - Street 1:641 W WILLOUGHBY AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1731
Practice Address - Country:US
Practice Address - Phone:907-586-5951
Practice Address - Fax:907-586-8017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPT0169261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK0000WCJPDMedicare ID - Type Unspecified