Provider Demographics
NPI:1932244068
Name:ALASKA AQUATIC THERAPY INC.
Entity Type:Organization
Organization Name:ALASKA AQUATIC THERAPY INC.
Other - Org Name:ALASKA AQUATIC THERAPY, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:190-739-8041
Mailing Address - Street 1:PO BOX 3313
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-3313
Mailing Address - Country:US
Mailing Address - Phone:907-283-7946
Mailing Address - Fax:
Practice Address - Street 1:35932 KENAI SPUR HWY
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7103
Practice Address - Country:US
Practice Address - Phone:907-398-0411
Practice Address - Fax:866-502-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKTC4600Medicaid
AKTC4600Medicaid