Provider Demographics
NPI:1932140308
Name:CHUGACH PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:CHUGACH PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE/BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEZLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-743-3310
Mailing Address - Street 1:2740 LAKE OTIS PKWY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4141
Mailing Address - Country:US
Mailing Address - Phone:907-743-3310
Mailing Address - Fax:907-272-8164
Practice Address - Street 1:2740 LAKE OTIS PKWY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4141
Practice Address - Country:US
Practice Address - Phone:907-743-3310
Practice Address - Fax:907-272-8164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2019-10-01
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1691679Medicaid
AK1031318Medicaid
A1344OtherPREMERA BLUE CROSS
AKTC3984Medicaid