Provider Demographics
NPI:1720326895
Name:ARCTIC PHYSICAL THERAPY AND REHABILITATION UNALASKA LLC
Entity Type:Organization
Organization Name:ARCTIC PHYSICAL THERAPY AND REHABILITATION UNALASKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-459-4108
Mailing Address - Street 1:1150 S COLONY WAY STE 3
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6972
Mailing Address - Country:US
Mailing Address - Phone:907-250-7246
Mailing Address - Fax:907-451-7244
Practice Address - Street 1:2029 AIRPORT BEACH RD
Practice Address - Street 2:
Practice Address - City:DUTCH HARBOR
Practice Address - State:AK
Practice Address - Zip Code:99690
Practice Address - Country:US
Practice Address - Phone:907-581-2204
Practice Address - Fax:907-451-7244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK225100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty