Basic Information
| Provider Information | |||||||||
| NPI: | 1013318047 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FREEDOM PHYSICAL THERAPY & SPORTS REHABILITATION, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1109 | ||||||||
| Address2: | |||||||||
| City: | KASILOF | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996101109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073351155 | ||||||||
| FaxNumber: | 9073351156 | ||||||||
| Practice Location | |||||||||
| Address1: | 6383 KENAI SPUR HWY | ||||||||
| Address2: | |||||||||
| City: | KENAI | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996118302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073351155 | ||||||||
| FaxNumber: | 9073351156 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2014 | ||||||||
| LastUpdateDate: | 01/27/2017 | ||||||||
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| AuthorizedOfficialLastName: | POLLOCK | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9073351155 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1448 | AK | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 1092 | AK | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.