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Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
3801 LAKE OTIS PKWY, SUITE 300, ANCHORAGE, AK 99508-5234
(907) 562-2277
(907) 563-3460
Mailing address
3801 LAKE OTIS PKWY, SUITE 300, ANCHORAGE, AK 99508-5234
(907) 562-2277
(907) 563-3460

Taxonomy

Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
1838
AK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1029494
AK
Enumeration date
12/20/2005
Last updated
02/29/2016
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