Provider Demographics
NPI:1831123165
Name:WILLOW PHYSICAL THERAPY, LIMITED
Entity Type:Organization
Organization Name:WILLOW PHYSICAL THERAPY, LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MURSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-456-5990
Mailing Address - Street 1:2555 PHILLIPS FIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3933
Mailing Address - Country:US
Mailing Address - Phone:907-456-5990
Mailing Address - Fax:907-374-8023
Practice Address - Street 1:544 4TH AVE # 102
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4714
Practice Address - Country:US
Practice Address - Phone:907-456-5990
Practice Address - Fax:907-374-8023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1838752251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1021170Medicaid
AKK0000WCRBYMedicare UPIN