Provider Demographics
NPI:1811584436
Name:BIRDLAND AK LLC
Entity Type:Organization
Organization Name:BIRDLAND AK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER, PT
Authorized Official - Prefix:
Authorized Official - First Name:TIMI
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:907-419-4210
Mailing Address - Street 1:3200 DOUGLAS HWY
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1918
Mailing Address - Country:US
Mailing Address - Phone:303-810-1638
Mailing Address - Fax:
Practice Address - Street 1:1601 SALMON CREEK LN
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7867
Practice Address - Country:US
Practice Address - Phone:907-419-4210
Practice Address - Fax:907-313-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty