Jacob Barrett Arvidson, DPT
Individual provider Active NPI Physical Therapist · Wasilla, AK
NPI 1689620643 · NPPES record last updated Apr 17, 2014
Key facts
- NPI
- 1689620643
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 1704 (AK)
- Practice address
- 401 E Bogard Rd
Wasilla, AK 99654-7108 - Phone
- (907) 357-2578
- Fax
- (907) 357-2529
- NPI assigned
- May 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Alyeska Therapy Center, Inc
Practice addresses (Care Compare)
401 E Bogard Rd
Wasilla, AK 99654-7108
Phone (907) 357-2578
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060818000066 | AK | Practitioner - Physical Therapist in Private Practice | 1052314713 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1704 | AK | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1704 | AK | Yes |
Addresses
Primary practice location
401 E Bogard Rd
Wasilla, AK 99654-7108
Mailing address
401 E Bogard Rd
Wasilla, AK 99654-7108
Phone (907) 357-2578
Other providers in Wasilla, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2014. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.