Fortitude, Inc
Organization Active NPI Physical Therapist · Kenai, AK
NPI 1609421502 · NPPES record last updated Jan 27, 2020
Key facts
- NPI
- 1609421502
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- FORTITUDE, INC
- Practice address
- 43900 Kenai Spur Hwy Unit C
Kenai, AK 99611-9708 - Phone
- (907) 283-3340
- Fax
- (907) 283-3349
- NPI assigned
- Aug 7, 2019
- Organization subpart
- No
Authorized official
- Name
- Dr. Donald Taylor Smith Staton, DPT
- Title
- President
- Phone
- (907) 283-3340
Practitioners 2
-
Nathan P Riley, PTA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191031002562 | AK | Part B Supplier - Clinic/Group Practice | 6002148616 |
Receives reassigned benefits from 1 practitioner Practice locations: Kenai, AK |
National Provider Directory
Locations
43900 Kenai Spur Hwy
Unit C
Kenai, AK 99611
Phone (907) 283-3340
43900 Kenai Spur Hwy
Kenai, AK 99611
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes |
Addresses
Primary practice location
43900 Kenai Spur Hwy Unit C
Kenai, AK 99611-9708
Mailing address
49066 Heights LN
Kenai, AK 99611-6112
Phone (907) 290-9973
Other providers in Kenai, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.