Provider Demographics
NPI:1962693176
Name:LIVING SYSTEMS PHYSICAL THERAPY
Entity type:Organization
Organization Name:LIVING SYSTEMS PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:DALEIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:907-272-1394
Mailing Address - Street 1:3417 VASSAR DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4332
Mailing Address - Country:US
Mailing Address - Phone:907-272-1394
Mailing Address - Fax:
Practice Address - Street 1:3417 VASSAR DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4332
Practice Address - Country:US
Practice Address - Phone:907-272-1394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK314260261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK161195Medicare PIN