1578935128 NPI number — DUPONT PHYSICAL THERAPY, INC., P.S.

Table of content: (NPI 1578935128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578935128 NPI number — DUPONT PHYSICAL THERAPY, INC., P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUPONT PHYSICAL THERAPY, INC., P.S.
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:
1578935128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 DENNIS ST SW STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUMWATER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98501-6523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-338-0181
Provider Business Mailing Address Fax Number:
360-338-0257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1525 WILMINGTON DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUPONT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98327-9999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-212-9670
Provider Business Practice Location Address Fax Number:
360-338-0257
Provider Enumeration Date:
10/22/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PROVOZNIK
Authorized Official First Name:
SHIRLEY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
VP OPERATIONS
Authorized Official Telephone Number:
360-338-0181

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)





Copyright © 2007-2025 www.npivalidator.com