NPIMap

Organization Active NPI

Home Town Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Fairbanks, AK
National Provider Identifier
1366478935
Registry record updated Feb 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
307473 Issued in AK
Legal business name
HOME TOWN PHYSICAL THERAPY, LLC
Practice address
2310 Peger Rd Ste 101
Fairbanks, AK 99709-5315
Phone
(907) 457-7678
Fax
(907) 457-7677
NPI assigned
Jun 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2011

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

Authorized official

Name
Mr. Gregory Scott MillesNPI 1902844376
Title
Physical Therapist
Phone
(907) 457-7678

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 Therapy Clinic/Center 261QP2000X 307473 AK Primary

Addresses

Primary practice location

2310 Peger Rd Ste 101
Fairbanks, AK 99709-5315

Mailing address

2310 Peger Rd Ste 101
Fairbanks, AK 99709-5315
Phone (907) 457-7678

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040929000135 AK Part B Supplier - Clinic/Group Practice 9931178753 Receives reassigned benefits from 9 practitioners
Practice locations: Fairbanks, AK

National Provider Directory

National Provider Directory

Locations

3407 Airport Way
Fairbanks, AK 99709
Phone (907) 456-4524

2310 Peger Rd
Ste 101
Fairbanks, AK 99709
Phone (907) 457-7678

2310 Peger Rd
Fairbanks, AK 99709
Phone (907) 458-7263

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297296000000",
    "number": "1366478935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 PEGER RD STE 101",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997095315",
            "telephone_number": "907-457-7678",
            "fax_number": "907-457-7677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 PEGER RD STE 101",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997095315",
            "telephone_number": "907-457-7678",
            "fax_number": "907-457-7677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOME TOWN PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2011-02-10",
        "status": "A",
        "authorized_official_last_name": "MILLES",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "907-457-7678",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "AK",
            "license": "307473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2011; 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.