1184606113 NPI number — DANIEL CARL BURNS MSPT INC PS

Table of content: (NPI 1184606113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184606113 NPI number — DANIEL CARL BURNS MSPT INC PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL CARL BURNS MSPT INC PS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OCEAN SHORES THERAPY SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184606113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1833
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEAN SHORES
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98569-1833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-289-0251
Provider Business Mailing Address Fax Number:
360-289-3226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
885 POINT BROWN AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEAN SHORES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98569-9682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-289-0251
Provider Business Practice Location Address Fax Number:
360-289-3226
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BURNS
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
CARL
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
360-289-0251

Provider Taxonomy Codes

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

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

  • Identifier: 7119159 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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