Provider Demographics
NPI:1164629853
Name:WISE PHYSICAL THERAPY AND REHABILITATION INC.
Entity type:Organization
Organization Name:WISE PHYSICAL THERAPY AND REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:907-562-2118
Mailing Address - Street 1:1200 AIRPORT HEIGHTS DR STE 170
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2986
Mailing Address - Country:US
Mailing Address - Phone:907-562-2118
Mailing Address - Fax:907-562-2128
Practice Address - Street 1:1200 AIRPORT HEIGHTS DR STE 170
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2986
Practice Address - Country:US
Practice Address - Phone:907-562-2118
Practice Address - Fax:907-562-2128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK742039225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1021187Medicaid