NPIMap

Organization Active NPI

Fairbanks Physical Therapy LLC

  • Physical Therapist
  • Fairbanks, AK
National Provider Identifier
1922396357
Registry record updated Jul 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1784 Issued in AK
Legal business name
FAIRBANKS PHYSICAL THERAPY LLC
Practice address
1755 Westwood Way
Suite 7
Fairbanks, AK 99709-4064
Phone
(907) 479-0623
Fax
(888) 761-9303
NPI assigned
Jul 19, 2011
Last updated
Jul 19, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2011

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

Authorized official

Name
Jeffrey S Gordon, PTNPI 1215008495
Title
Owner
Phone
(907) 479-0623

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 TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 1784 AK Primary

Addresses

Primary practice location

1755 Westwood Way
Suite 7
Fairbanks, AK 99709-4064

Mailing address

315 Illinois St
Fairbanks, AK 99701-2910
Phone (907) 456-7767

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120504000005 AK Part B Supplier - Clinic/Group Practice 8426210683 Receives reassigned benefits from 1 practitioner
Practice locations: Fairbanks, AK

National Provider Directory

National Provider Directory

Locations

1755 Westwood Way
Ste 7
Fairbanks, AK 99709
Phone (907) 479-0623

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1311033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311033600000",
    "number": "1922396357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 ILLINOIS ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997012910",
            "telephone_number": "907-456-7767",
            "fax_number": "907-456-8050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1755 WESTWOOD WAY",
            "address_2": "SUITE 7",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997094064",
            "telephone_number": "907-479-0623",
            "fax_number": "888-761-9303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRBANKS PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-19",
        "last_updated": "2011-07-19",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-479-0623",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "AK",
            "license": "1784",
            "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 Jul 19, 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.