Provider Demographics
NPI:1386817732
Name:ARCTIC PHYSICAL THERAPY SERVICES, INC.
Entity type:Organization
Organization Name:ARCTIC PHYSICAL THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:B
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:907-486-4499
Mailing Address - Street 1:813 LOWER MILL BAY RD
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-7314
Mailing Address - Country:US
Mailing Address - Phone:907-486-4499
Mailing Address - Fax:907-486-8211
Practice Address - Street 1:813 LOWER MILL BAY RD
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-7314
Practice Address - Country:US
Practice Address - Phone:907-486-4499
Practice Address - Fax:907-486-8211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK277835261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPO0957Medicaid
AKMS09571Medicaid
AKPO0957Medicaid