Individual
JESSIKA LARUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
35105 KENAI SPUR HWY STE A, SOLDOTNA, AK 99669-7658
(907) 260-7444
Mailing address
35105 KENAI SPUR HWY STE A, SOLDOTNA, AK 99669-7658
(907) 260-7444
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
130306
AK
225100000X
Physical Therapist
61026
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902279011
—
OR
Enumeration date
11/11/2015
Last updated
07/16/2020
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