Organization
IDEAL MOTION PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRIS WILSON PT (OWNER)
(907) 694-5515
Entity
Organization
Contact information
Practice address
12551 OLD GLENN HWY STE E, EAGLE RIVER, AK 99577-7590
(907) 694-5515
(907) 694-5575
Mailing address
12551 OLD GLENN HWY STE E, EAGLE RIVER, AK 99577-7590
(907) 694-5515
(907) 694-5575
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
1021707
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1029575
—
AK
Enumeration date
09/15/2015
Last updated
01/22/2020
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