1497102792 NPI number — SKAGIT ISLAND REHABILITATION GROUP LLC

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 1497102792 NPI number — SKAGIT ISLAND REHABILITATION GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SKAGIT ISLAND REHABILITATION GROUP LLC
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:
6
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:
1497102792
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 R AVE UNIT 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANACORTES
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98221-4602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-293-2417
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32650 STATE ROUTE 20 # E110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK HARBOR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98277-2641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-279-0100
Provider Business Practice Location Address Fax Number:
360-279-0111
Provider Enumeration Date:
05/17/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
VOREE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, MPT
Authorized Official Telephone Number:
360-279-0100

Provider Taxonomy Codes

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

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





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