# VACCA PHYSIATRY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528456696
- **Authorized official:** BRIAN D VACCA MD (OWNER/SOLE PROVIDER)
- **Authorized official phone:** (907) 622-1300

## Contact information

- **Practice address:** 10928 EAGLE RIVER RD, SUITE 104, EAGLE RIVER, AK 99577-8078
- **Practice address phone:** (907) 622-1300
- **Mailing address:** 10928 EAGLE RIVER RD, SUITE 104, EAGLE RIVER, AK 99577-8078
- **Mailing address phone:** (907) 622-1300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 51455 | MN | — |
| 261QM2500X | Medical Specialty Clinic/Center | 103783 | AK | Yes |

## Other

- **Enumeration date:** 12/24/2014
- **Last updated:** 06/07/2016