Provider Demographics
NPI:1487798427
Name:SEETHALER, LARRY (LPT)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:SEETHALER
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 E TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1136
Mailing Address - Country:US
Mailing Address - Phone:907-561-5006
Mailing Address - Fax:907-562-2398
Practice Address - Street 1:2704 E TUDOR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1136
Practice Address - Country:US
Practice Address - Phone:907-561-5006
Practice Address - Fax:907-562-2398
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2252251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT2250Medicaid
AKPT2250Medicaid