Provider Demographics
NPI:1023154374
Name:GOERANSSON, CARLA JOYCE (PT)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:JOYCE
Last Name:GOERANSSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 TURNAGAIN PKWY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-1168
Mailing Address - Country:US
Mailing Address - Phone:907-243-2904
Mailing Address - Fax:
Practice Address - Street 1:641 W WILLOUGHBY AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1731
Practice Address - Country:US
Practice Address - Phone:907-586-5951
Practice Address - Fax:907-586-8017
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPT 0169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT0169Medicaid
AKPT0169Medicaid