Provider Demographics
NPI:1861248007
Name:MOUNT SUSITNA THERAPEUTIC ASSOCIATES, LLC
Entity type:Organization
Organization Name:MOUNT SUSITNA THERAPEUTIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:907-214-1303
Mailing Address - Street 1:PO BOX 770544
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-0544
Mailing Address - Country:US
Mailing Address - Phone:907-214-1303
Mailing Address - Fax:907-206-7212
Practice Address - Street 1:12641 OLD GLENN HWY STE 202
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7040
Practice Address - Country:US
Practice Address - Phone:907-214-1303
Practice Address - Fax:907-206-7212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty