Provider Demographics
NPI:1295913135
Name:JAMMIN' SALMONS' PHYSICAL & NUTRITIONAL THERAPIES, INC.
Entity type:Organization
Organization Name:JAMMIN' SALMONS' PHYSICAL & NUTRITIONAL THERAPIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SALMON
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:907-457-6688
Mailing Address - Street 1:828 CROSSMAN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-1413
Mailing Address - Country:US
Mailing Address - Phone:907-457-6688
Mailing Address - Fax:907-452-6488
Practice Address - Street 1:828 CROSSMAN RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99712-1413
Practice Address - Country:US
Practice Address - Phone:907-457-6688
Practice Address - Fax:907-452-6488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK151438Medicare UPIN