1437394715 NPI number — BRITEVALE PHYSICAL THERAPY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437394715 NPI number — BRITEVALE PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRITEVALE PHYSICAL THERAPY
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:
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:
1437394715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 ONEIL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OROVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98844-9780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-476-3373
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OROVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98844-9384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-476-2020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THORNTON
Authorized Official First Name:
SONJA
Authorized Official Middle Name:
KATHLEEN
Authorized Official Title or Position:
PT
Authorized Official Telephone Number:
509-476-3373

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT00003755 , 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)