1780919548 NPI number — SKAGIT ISLAND REHABILITATION GROUP

Table of content: (NPI 1780919548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780919548 NPI number — SKAGIT ISLAND REHABILITATION GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SKAGIT ISLAND REHABILITATION GROUP
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:
MOUNT VERNON PHYSICAL THERAPY
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:
1780919548
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 R AVE
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:
360-293-2516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 N 1ST ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98273-2859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-336-3838
Provider Business Practice Location Address Fax Number:
360-336-3880
Provider Enumeration Date:
10/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
FRITZ
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
OWNER/P.T.
Authorized Official Telephone Number:
360-336-3838

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT00003585 , 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)





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