Basic Information
| Provider Information | |||||||||
| NPI: | 1427258466 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MORMILE PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 201773 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995201773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077702308 | ||||||||
| FaxNumber: | 9077702325 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 A ST | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995015145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075611800 | ||||||||
| FaxNumber: | 9075624705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2007 | ||||||||
| LastUpdateDate: | 01/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | MORMILE | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9075611800 | ||||||||
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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 | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.