NPIMap

Organization Active NPI

Wasilla Physical Therapy Inc.

  • Physical Therapist
  • Wasilla, AK
National Provider Identifier
1023364205
Registry record updated Jul 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
WASILLA PHYSICAL THERAPY INC.
Practice address
3750 E Country Field Cir Ste a
Wasilla, AK 99654-6659
Phone
(907) 376-7334
Fax
(907) 373-1429
NPI assigned
Jul 25, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert Orville BrownNPI 1134470867
Title
Owner/Manager
Phone
(907) 376-7334

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

3750 E Country Field Cir Ste a
Wasilla, AK 99654-6659

Mailing address

3750 E Country Field Cir Ste a
Wasilla, AK 99654-6659
Phone (907) 376-7334

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121222000035 AK Part B Supplier - Clinic/Group Practice 1456504448 Receives reassigned benefits from 10 practitioners
Practice locations: Wasilla, AK

National Provider Directory

National Provider Directory

Locations

3750 E Country Field Cir
Wasilla, AK 99654
Phone (907) 376-7334

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343174400000",
    "number": "1023364205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3750 E COUNTRY FIELD CIR STE A",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996546659",
            "telephone_number": "907-376-7334",
            "fax_number": "907-373-1429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3750 E COUNTRY FIELD CIR STE A",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996546659",
            "telephone_number": "907-376-7334",
            "fax_number": "907-373-1429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASILLA PHYSICAL THERAPY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-25",
        "last_updated": "2012-07-25",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "ORVILLE",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "907-376-7334"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wasilla, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.