1427237619 NPI number — TIMBERLINE REHABILITATION SERVICE, PS

Table of content: (NPI 1427237619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427237619 NPI number — TIMBERLINE REHABILITATION SERVICE, PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIMBERLINE REHABILITATION SERVICE, 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:
1427237619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
916 NE 112TH AVE
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98684-5104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-567-2002
Provider Business Mailing Address Fax Number:
360-567-2005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
916 NE 112TH AVE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98684-5104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-567-2002
Provider Business Practice Location Address Fax Number:
360-567-2005
Provider Enumeration Date:
10/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
ZANE
Authorized Official Middle Name:
ARTHUR
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
360-567-2002

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)

  • Identifier: 1427237619 . This is a "GROUP NPI #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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