1366406910 NPI number — MR. JASON STREIF WILWERT MPT, OCS

Table of content: MR. JASON STREIF WILWERT MPT, OCS (NPI 1366406910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366406910 NPI number — MR. JASON STREIF WILWERT MPT, OCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILWERT
Provider First Name:
JASON
Provider Middle Name:
STREIF
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MPT, OCS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1366406910
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
293 S RIDGEVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT ANGELES
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-457-1683
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 B W SPRUCE
Provider Second Line Business Practice Location Address:
SEQUIM PHYSICAL THERAPY CTR PS
Provider Business Practice Location Address City Name:
SEQUIM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-683-0632
Provider Business Practice Location Address Fax Number:
360-681-8453
Provider Enumeration Date:
04/12/2006

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:  PT00007329 , 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: 0173768 . This is a "WORKMAN'S COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: DA1273 . This is a "MR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8355117 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0170268 . This is a "WORKMAN'S COMP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0170268 . This is a "L & I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 81061006701 . This is a "KPS INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8106WI . This is a "REGENCE INS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00017905 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: DA1273 . This is a "RAILROAD MEDICARE GRP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7117260 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com