Provider Demographics
NPI:1427258466
Name:MORMILE PHYSICAL THERAPY
Entity type:Organization
Organization Name:MORMILE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORMILE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:907-561-1800
Mailing Address - Street 1:PO BOX 201773
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99520-1773
Mailing Address - Country:US
Mailing Address - Phone:907-770-2308
Mailing Address - Fax:907-770-2325
Practice Address - Street 1:1600 A ST
Practice Address - Street 2:SUITE 215
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-5145
Practice Address - Country:US
Practice Address - Phone:907-561-1800
Practice Address - Fax:907-562-4705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK0000WCKJTMedicare PIN