NPIMap

Organization Active NPI

East Side Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Anchorage, AK
National Provider Identifier
1972800266
Registry record updated Feb 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
1416 Issued in AK
Legal business name
EAST SIDE PHYSICAL THERAPY, LLC
Practice address
6901 Debarr Rd
Suite 1E
Anchorage, AK 99504-1806
Phone
(907) 332-3778
Fax
(907) 332-3790
NPI assigned
Feb 22, 2011
Last updated
Feb 22, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2011

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

Authorized official

Name
Dr. Jeanna Marie Duryee, D.P.T.NPI 1265739098
Title
Member/Owner
Phone
(907) 332-3778

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 1416 AK Primary

Addresses

Primary practice location

6901 Debarr Rd
Suite 1E
Anchorage, AK 99504-1806

Mailing address

6901 Debarr Rd
Suite 1E
Anchorage, AK 99504-1806
Phone (907) 332-3778

Other names 1

  • DJM: Rehab, Fintess & Therapy Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110414000882 AK Part B Supplier - Clinic/Group Practice 2961686985 Receives reassigned benefits from 2 practitioners
Practice locations: Anchorage, AK

National Provider Directory

National Provider Directory

Locations

6901 Debarr Rd
Ste 1E
Anchorage, AK 99504
Phone (907) 332-3778

Practitioners & affiliated clinicians

Practitioners 3

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": "1298332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298332800000",
    "number": "1972800266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6901 DEBARR RD",
            "address_2": "SUITE 1E",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995041806",
            "telephone_number": "907-332-3778",
            "fax_number": "907-332-3790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6901 DEBARR RD",
            "address_2": "SUITE 1E",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995041806",
            "telephone_number": "907-332-3778",
            "fax_number": "907-332-3790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST SIDE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-22",
        "last_updated": "2011-02-22",
        "status": "A",
        "authorized_official_last_name": "DURYEE",
        "authorized_official_first_name": "JEANNA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "MEMBER/OWNER",
        "authorized_official_telephone_number": "907-332-3778",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "AK",
            "license": "1416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DJM: Rehab, Fintess & Therapy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Anchorage, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 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.