1972850774 NPI number — ABILITY PEDIATRIC PHYSICAL THERAPY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972850774 NPI number — ABILITY PEDIATRIC PHYSICAL THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABILITY PEDIATRIC PHYSICAL THERAPY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972850774
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 241769
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99524-1769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-770-2380
Provider Business Mailing Address Fax Number:
907-770-2341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4325 LAUREL ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-5364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-569-5660
Provider Business Practice Location Address Fax Number:
888-783-9518
Provider Enumeration Date:
08/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
POMEROY
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER/PROVIDER
Authorized Official Telephone Number:
907-569-5660

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , with the licence number:  977621 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com