Basic Information
| Provider Information | |||||||||
| NPI: | 1508528472 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMPOWER PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3190 E MERIDIAN PARK LOOP STE 206 | ||||||||
| Address2: | |||||||||
| City: | WASILLA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996547422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073739462 | ||||||||
| FaxNumber: | 9073739464 | ||||||||
| Practice Location | |||||||||
| Address1: | 3190 E MERIDIAN PARK LOOP STE 206 | ||||||||
| Address2: | |||||||||
| City: | WASILLA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996547422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073739462 | ||||||||
| FaxNumber: | 9073739464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2021 | ||||||||
| LastUpdateDate: | 10/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | POLLARD | ||||||||
| AuthorizedOfficialFirstName: | JACOB | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2082206886 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT, DPT | ||||||||
| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.