1649248154 NPI number — WINTHROP PHYSICAL THERAPY PS

Table of content: (NPI 1649248154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649248154 NPI number — WINTHROP PHYSICAL THERAPY PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINTHROP PHYSICAL THERAPY 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:
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:
1649248154
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 814
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTHROP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98862-0814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-996-8234
Provider Business Mailing Address Fax Number:
509-996-2193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 WHITE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTHROP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98862-9774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-996-8234
Provider Business Practice Location Address Fax Number:
509-996-2193
Provider Enumeration Date:
03/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DICKINSON
Authorized Official First Name:
PETER
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
509-996-8234

Provider Taxonomy Codes

  • Taxonomy code: 2251S0007X , with the licence number:  602118917 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7120769 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 602118917 . This is a "UNIFIED BUSINESS IDENTIFI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0200051 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 193601200 . This is a "US DEPT OF LABOR OWCP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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