Organization
VACCA PHYSIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN D VACCA MD (OWNER/SOLE PROVIDER)
(907) 622-1300
Entity
Organization
Contact information
Practice address
10928 EAGLE RIVER RD, SUITE 104, EAGLE RIVER, AK 99577-8078
(907) 622-1300
Mailing address
10928 EAGLE RIVER RD, SUITE 104, EAGLE RIVER, AK 99577-8078
(907) 622-1300
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
51455
MN
261QM2500X
Medical Specialty Clinic/Center
Primary
103783
AK
Other
Enumeration date
12/24/2014
Last updated
06/07/2016
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