Organization
BACKCOUNTRY THERAPEUTICS LLC
Active
Other names
Backcountry Therapeutics
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANDREA LEUTZINGER MOT (OWNER, PROVIDER)
(907) 982-3897
Entity
Organization
Contact information
Practice address
619 S KNIK GOOSE BAY RD, WASILLA, AK 99654-8075
(907) 982-3897
(866) 283-2986
Mailing address
PO BOX 876104, WASILLA, AK 99687-6104
(907) 982-3897
(866) 283-2986
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2195
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1570638
—
AK
Enumeration date
12/16/2014
Last updated
03/11/2016
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