1043870405 NPI number — JENNIFER ELIZABETH ARTIS DPT

Table of content: JENNIFER ELIZABETH ARTIS DPT (NPI 1043870405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043870405 NPI number — JENNIFER ELIZABETH ARTIS DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARTIS
Provider First Name:
JENNIFER
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RHODENBAUGH
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043870405
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 NW MYHRE RD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVERDALE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98383
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-598-3764
Provider Business Mailing Address Fax Number:
360-598-3282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KITSAP PHYSICAL THERAPY AND SPORTS CLINIC
Provider Second Line Business Practice Location Address:
19505 7TH AVE
Provider Business Practice Location Address City Name:
POULSBO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-779-3777
Provider Business Practice Location Address Fax Number:
360-598-3202
Provider Enumeration Date:
06/18/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT61127979 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)