Provider Demographics
NPI:1801849211
Name:ALASKA PHYSICAL THERAPY SPECIALISTS, LLC
Entity Type:Organization
Organization Name:ALASKA PHYSICAL THERAPY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:907-561-4280
Mailing Address - Street 1:3650 LAKE OTIS PARKWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-561-4280
Mailing Address - Fax:907-561-4282
Practice Address - Street 1:3650 LAKE OTIS PARKWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-561-4280
Practice Address - Fax:907-561-4282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK431746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK153143Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER