Provider Demographics
NPI:1821211616
Name:RISUNG, KJELL B (PT)
Entity Type:Individual
Prefix:MR
First Name:KJELL
Middle Name:B
Last Name:RISUNG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FRONTIER THERAPY SERVICES
Mailing Address - Street 2:108 EAST CORRAL
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669
Mailing Address - Country:US
Mailing Address - Phone:907-260-5893
Mailing Address - Fax:907-260-5814
Practice Address - Street 1:FRONTIER THERAPY SERVICES
Practice Address - Street 2:108 EAST CORRAL
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669
Practice Address - Country:US
Practice Address - Phone:907-260-5893
Practice Address - Fax:907-260-5814
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5352251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKTC851Medicaid
AK026530Medicare ID - Type Unspecified