| NPI | 1528456696 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN D VACCA Owner/Sole Provider 907-622-1300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: AK 103783) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 51455) |
| Enumeration Date | 2014-12-24 |
| Last Update Date | 2016-06-07 |