Provider Demographics
NPI:1972800266
Name:EAST SIDE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:EAST SIDE PHYSICAL THERAPY, LLC
Other - Org Name:DJM: REHAB, FINTESS & THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DURYEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:907-332-3778
Mailing Address - Street 1:6901 DEBARR RD
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1806
Mailing Address - Country:US
Mailing Address - Phone:907-332-3778
Mailing Address - Fax:907-332-3790
Practice Address - Street 1:6901 DEBARR RD
Practice Address - Street 2:SUITE 1E
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1806
Practice Address - Country:US
Practice Address - Phone:907-332-3778
Practice Address - Fax:907-332-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1416261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy