Provider Demographics
NPI:1255388492
Name:HUTTUNEN, ALICE (PT)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:HUTTUNEN
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:PO BOX 874105
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-4105
Mailing Address - Country:US
Mailing Address - Phone:907-376-2975
Mailing Address - Fax:
Practice Address - Street 1:591 N KNIK ST
Practice Address - Street 2:SUITE F
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7050
Practice Address - Country:US
Practice Address - Phone:907-357-2578
Practice Address - Fax:907-357-2529
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPT 214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT0214Medicaid
AKPT 02141Medicaid
AKPT 02141Medicaid