Provider Demographics
NPI:1932489382
Name:GIESEN, ERIC NATHAN (DPT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:NATHAN
Last Name:GIESEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E BOGARD RD
Mailing Address - Street 2:SUITE B-203
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6563
Mailing Address - Country:US
Mailing Address - Phone:907-376-4325
Mailing Address - Fax:907-376-2365
Practice Address - Street 1:1700 E BOGARD RD
Practice Address - Street 2:SUITE B-203
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6563
Practice Address - Country:US
Practice Address - Phone:907-376-4325
Practice Address - Fax:907-376-2365
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist