Provider Demographics
NPI:1962902197
Name:KENAI PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:KENAI PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ SOLE OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:AVANT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:907-235-0687
Mailing Address - Street 1:4107 HOHE AVE.
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7008
Mailing Address - Country:US
Mailing Address - Phone:907-235-0687
Mailing Address - Fax:907-235-4017
Practice Address - Street 1:4107 HOHE AVE.
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7008
Practice Address - Country:US
Practice Address - Phone:907-235-0687
Practice Address - Fax:907-235-4017
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENAI PHYSICAL THERAPY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1042393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty