Organization
MAT-SU SERVICES FOR CHILDREN & ADULTS
Active
Organization
MAT-SU SERVICES FOR CHILDREN & ADULTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KALEB JOHNSON (EXECUTIVE DIRECTOR)
(907) 352-1200
Entity
Organization
Contact information
Practice address
1225 W SPRUCE AVE, WASILLA, AK 99654-5326
(907) 352-1200
(907) 352-1249
Mailing address
1225 W SPRUCE AVE, WASILLA, AK 99654-5326
(907) 352-1200
(907) 352-1249
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
403503
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMG450
—
AK
Enumeration date
03/16/2007
Last updated
06/03/2026
Update your record
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