Provider Demographics
NPI:1205355369
Name:HANDY, JUSTIN CACHE (DPT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:CACHE
Last Name:HANDY
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 1:3066 E MERIDIAN PARK LOOP STE 3
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7254
Mailing Address - Country:US
Mailing Address - Phone:907-357-9590
Mailing Address - Fax:907-357-9593
Practice Address - Street 1:4361 BONIFACE PKWY STE 3
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4316
Practice Address - Country:US
Practice Address - Phone:907-373-9462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-10
Last Update Date:2017-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK125568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK125568OtherSTATE OF ALASKA PROFESSIONAL LICENSE