Active NPI
Ideal Motion Physical Therapy LLC
- Physical Therapy Clinic/Center
- Eagle River, AK
National Provider Identifier
1124497540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Clinic/Center
- License
- 1021707
- Legal business name
- IDEAL MOTION PHYSICAL THERAPY LLC
- Practice address
- 12551 Old Glenn Hwy Ste E
Eagle River, AK 99577-7590 - Phone
- (907) 694-5515
- Fax
- (907) 694-5575
- NPI assigned
- Sep 15, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Chris Wilson, PT
- Title
- Owner
- Phone
- (907) 694-5515
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | 1021707 | AK | Primary |
Addresses
Primary practice location
12551 Old Glenn Hwy Ste E
Eagle River, AK 99577-7590
Mailing address
12551 Old Glenn Hwy Ste E
Eagle River, AK 99577-7590
Phone (907) 694-5515
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1029575 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AK
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160127000678 | AK | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 3476856345 |
Receives reassigned benefits from 3 practitioners Practice locations: Eagle River, AK |
National Provider Directory
National Provider DirectoryLocations
12551 Old Glenn Hwy
Ste E
Eagle River, AK 99577
Phone (907) 694-5515
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Physical Therapist
- Eagle River, AK
- NPI 1972554814
AK, Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442275200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1579651200000",
"number": "1124497540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12551 OLD GLENN HWY STE E",
"city": "EAGLE RIVER",
"state": "AK",
"postal_code": "995777590",
"telephone_number": "907-694-5515",
"fax_number": "907-694-5575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12551 OLD GLENN HWY STE E",
"city": "EAGLE RIVER",
"state": "AK",
"postal_code": "995777590",
"telephone_number": "907-694-5515",
"fax_number": "907-694-5575"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "IDEAL MOTION PHYSICAL THERAPY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-09-15",
"last_updated": "2020-01-22",
"certification_date": "2020-01-22",
"status": "A",
"authorized_official_last_name": "WILSON",
"authorized_official_first_name": "CHRIS",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "907-694-5515",
"authorized_official_credential": "PT"
},
"taxonomies": [
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "AK",
"license": "1021707",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1029575",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eagle River, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; 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.