Provider Demographics
NPI:1528126794
Name:ASCENSION PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ASCENSION PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:AUTREY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:907-770-6693
Mailing Address - Street 1:6200 LAKE OTIS PKWY
Mailing Address - Street 2:STE 104
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507
Mailing Address - Country:US
Mailing Address - Phone:907-770-6693
Mailing Address - Fax:907-770-6697
Practice Address - Street 1:6200 LAKE OTIS PKWY
Practice Address - Street 2:STE 104
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507
Practice Address - Country:US
Practice Address - Phone:907-770-6693
Practice Address - Fax:907-770-6697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
152744Medicare ID - Type Unspecified