Northern Edge Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

1581 Issued in AK

Legal business name

NORTHERN EDGE PHYSICAL THERAPY LLC

Practice address

984 N Meridian PL Ste a
Wasilla, AK 99654-7215

Phone

(907) 631-4029

Fax

(907) 631-4128

NPI assigned

Nov 16, 2012

Organization subpart

No

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

Authorized official

Name

Keith Poorbaugh, PT, SCD

Title

Owner/Manager

Phone

(907) 631-4029

Specialties & licenses 1

Addresses

Other names 1

• Northern Edge Physical Therapy Doing business as

Locations

Practitioners 2

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

• Benjamin Alden Cockfield, DPT, PT

  • Physical Therapist
  • Wasilla, AK
  • NPI 1902598162
  NPD (past)
• Jeanette Stack, LMP

  • Massage Therapist
  • Wasilla, AK
  • NPI 1548407497
  NPD (past)

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

{
    "created_epoch": "1353024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649721600000",
    "number": "1467796359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "984 N MERIDIAN PL # A",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547215",
            "telephone_number": "907-631-4029",
            "fax_number": "907-631-4128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "984 N MERIDIAN PL STE A",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547215",
            "telephone_number": "907-631-4029",
            "fax_number": "907-631-4128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN EDGE PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-16",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A",
        "authorized_official_last_name": "POORBAUGH",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "907-631-4029",
        "authorized_official_credential": "PT, SCD"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "AK",
            "license": "1581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Edge Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hans Patrick Nordstrom, DDS
• Emily Norris
• Samantha Jennings Norris, RBT
• Northern Dentistry Inc.
• Northern Edge Physical Therapy Limited Partnership
• Northern Living Center LLC
• Northern Living Centers, LLC
• Northern Living Centers, LLC
• Northern Neurology, LLC
• Northern Orthopedics Inc

• Physical Therapy Clinic/Center in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Physical Therapy Clinic/Center in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; 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.