Provider Demographics
NPI:1871831032
Name:ARCTIC PHYSICAL THERAPY AND REHABILITATION FAIRBANKS LLC
Entity Type:Organization
Organization Name:ARCTIC PHYSICAL THERAPY AND REHABILITATION FAIRBANKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-459-4108
Mailing Address - Street 1:308 OLD STEESE HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3126
Mailing Address - Country:US
Mailing Address - Phone:425-760-9649
Mailing Address - Fax:
Practice Address - Street 1:330 OLD STEESE HWY
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3126
Practice Address - Country:US
Practice Address - Phone:206-459-4108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty