Provider Demographics
NPI:1013344670
Name:ARCTIC REHABILITATION AND PHYSICAL THERAPY ANCHORAGE LLC
Entity Type:Organization
Organization Name:ARCTIC REHABILITATION AND PHYSICAL THERAPY ANCHORAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-982-3000
Mailing Address - Street 1:1150 S COLONY WAY STE 3 PMB 226
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645
Mailing Address - Country:US
Mailing Address - Phone:907-982-3000
Mailing Address - Fax:208-457-3120
Practice Address - Street 1:5701 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1701
Practice Address - Country:US
Practice Address - Phone:907-277-3422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2632111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK2632OtherBUISNESS LICENSE