Provider Demographics
NPI:1891208351
Name:MEDICAL GROUP OF ALASKA
Entity Type:Organization
Organization Name:MEDICAL GROUP OF ALASKA
Other - Org Name:EMPOWER PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY-MUSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-357-7710
Mailing Address - Street 1:3190 E MERIDIAN PARK LOOP STE 206
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7422
Mailing Address - Country:US
Mailing Address - Phone:907-357-7710
Mailing Address - Fax:907-357-7720
Practice Address - Street 1:3190 E MERIDIAN PARK LOOP STE 206A
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7422
Practice Address - Country:US
Practice Address - Phone:907-373-9462
Practice Address - Fax:907-373-9464
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL GROUP OF ALASKA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-07
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1061557261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1061557OtherBUSINESS LICENSE