Robert O Brown
Individual provider Active NPI Physical Therapist · Wasilla, AK
NPI 1134470867 · NPPES record last updated Sep 20, 2012
Key facts
- NPI
- 1134470867
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 2125 (AK)
- Practice address
- 3750 E Country Field Cir Ste a
Wasilla, AK 99654-6659 - Phone
- (907) 376-7334
- Fax
- (907) 373-1429
- NPI assigned
- Sep 20, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2125 | AK | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wasilla Physical Therapy Inc. | Physical Therapist | Current | Accepting new patients |
Locations
3750 E Country Field Cir
Ste A
Wasilla, AK 99654
Phone (907) 376-3774
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2125 | AK | Yes |
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
Other providers in Wasilla, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.