Active NPI
Susan V Pettis, PT
- Physical Therapist
- Anchorage, AK
National Provider Identifier
1346204658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 67
- Practice address
- 11551 Tanglewood Lake Circle
Suite 2
Anchorage, AK 99516-1304 - Phone
- (907) 562-7745
- Fax
- (907) 562-7808
- NPI assigned
- Apr 13, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 67 | AK | Primary |
Addresses
Primary practice location
11551 Tanglewood Lake Circle
Suite 2
Anchorage, AK 99516-1304
Mailing address
PO Box 241769
Anchorage, AK 99524-1769
Phone (907) 770-2380
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT0577 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 67 | AK | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283385600000",
"number": "1346204658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 241769",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995241769",
"telephone_number": "907-770-2380",
"fax_number": "907-770-2341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11551 TANGLEWOOD LAKE CIRCLE",
"address_2": "SUITE 2",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995161304",
"telephone_number": "907-562-7745",
"fax_number": "907-562-7808"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTIS",
"first_name": "SUSAN",
"middle_name": "V",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-13",
"last_updated": "2010-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AK",
"license": "67",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PT0577",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anchorage, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.