1982721874 NPI number — INDEPENDENT PHYSICAL THERAPY, INC

Table of content: (NPI 1982721874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982721874 NPI number — INDEPENDENT PHYSICAL THERAPY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDEPENDENT PHYSICAL THERAPY, INC
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:
PENINSULA 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:
1982721874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 457
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAIR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98528-0457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-275-6612
Provider Business Mailing Address Fax Number:
360-275-6658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 NE ROMANCE HILL RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELFAIR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-275-6612
Provider Business Practice Location Address Fax Number:
360-275-6658
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PETERSEN
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE MGR
Authorized Official Telephone Number:
360-275-6612

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT00007051 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XH1200X , with the licence number: 00002504 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1265433601 . This is a "NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com