Provider Demographics
NPI:1134246804
Name:ALASKA, JEFFREY GEORGE (MPT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:GEORGE
Last Name:ALASKA
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42436 ARCADIA DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-2608
Mailing Address - Country:US
Mailing Address - Phone:586-726-6277
Mailing Address - Fax:
Practice Address - Street 1:46591 ROMEO PLANK RD
Practice Address - Street 2:SUITE 115
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5742
Practice Address - Country:US
Practice Address - Phone:586-226-6500
Practice Address - Fax:586-226-6505
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist