NPIMap

Organization Active NPI

Backcountry Therapeutics LLC

  • Occupational Therapist
  • Wasilla, AK
National Provider Identifier
1184022550
Registry record updated Mar 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
2195 Issued in AK
Legal business name
BACKCOUNTRY THERAPEUTICS LLC
Practice address
619 S Knik Goose Bay Rd
Wasilla, AK 99654-8075
Phone
(907) 982-3897
Fax
(866) 283-2986
NPI assigned
Dec 16, 2014
Last updated
Mar 11, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2016

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

Authorized official

Name
Ms. Andrea Leutzinger, MOT
Title
Owner, Provider
Phone
(907) 982-3897

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 2195 AK Primary

Addresses

Primary practice location

619 S Knik Goose Bay Rd
Wasilla, AK 99654-8075

Mailing address

PO Box 876104
Wasilla, AK 99687-6104
Phone (907) 982-3897

Other identifiers 1

IdentifierTypeStateIssuer
1570638MedicaidAK

Other names 1

  • Backcountry Therapeutics Former legal business name

National Provider Directory

National Provider Directory

Locations

619 S Knik Goose Bay Rd
Wasilla, AK 99654
Phone (907) 982-3897

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1418688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457654400000",
    "number": "1184022550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 876104",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996876104",
            "telephone_number": "907-982-3897",
            "fax_number": "866-283-2986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 S KNIK GOOSE BAY RD",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996548075",
            "telephone_number": "907-982-3897",
            "fax_number": "866-283-2986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACKCOUNTRY THERAPEUTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-16",
        "last_updated": "2016-03-11",
        "status": "A",
        "authorized_official_last_name": "LEUTZINGER",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "OWNER, PROVIDER",
        "authorized_official_telephone_number": "907-982-3897",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MOT"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "AK",
            "license": "2195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1570638",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Backcountry Therapeutics",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Mar 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.