Provider Demographics
NPI:1851422935
Name:DENALI MESA CORPORATION
Entity Type:Organization
Organization Name:DENALI MESA CORPORATION
Other - Org Name:FRONTIER THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KINNEBREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-258-8618
Mailing Address - Street 1:907 E DOWLING RD
Mailing Address - Street 2:STE 26
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1424
Mailing Address - Country:US
Mailing Address - Phone:907-258-8618
Mailing Address - Fax:
Practice Address - Street 1:108 E CORRAL AVE
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7524
Practice Address - Country:US
Practice Address - Phone:907-260-5893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK193978503OtherDEPT OF LABOR
AKTC6851Medicaid
AKTC6851Medicaid