Individual
JACK L WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
3035 PALMER WASILLA HWY STE 401, WASILLA, AK 99654-7274
(907) 376-8590
Mailing address
3035 PALMER WASILLA HWY STE 401, WASILLA, AK 99654-7234
(907) 376-8590
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1762
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PT9623
—
AK
Enumeration date
12/04/2006
Last updated
07/09/2007
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