Provider Demographics
NPI:1013318047
Name:FREEDOM PHYSICAL THERAPY & SPORTS REHABILITATION, LLC
Entity Type:Organization
Organization Name:FREEDOM PHYSICAL THERAPY & SPORTS REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:907-335-1155
Mailing Address - Street 1:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:KASILOF
Mailing Address - State:AK
Mailing Address - Zip Code:99610-1109
Mailing Address - Country:US
Mailing Address - Phone:907-335-1155
Mailing Address - Fax:907-335-1156
Practice Address - Street 1:6383 KENAI SPUR HWY
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-8302
Practice Address - Country:US
Practice Address - Phone:907-335-1155
Practice Address - Fax:907-335-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1092225100000X
AK1448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty