1609815331 NPI number — BRAD WAYNE BILLINGTON P.T.

Table of content: BRAD WAYNE BILLINGTON P.T. (NPI 1609815331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609815331 NPI number — BRAD WAYNE BILLINGTON P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BILLINGTON
Provider First Name:
BRAD
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BILLINGTON
Provider Other First Name:
BRADLEY
Provider Other Middle Name:
WAYNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1609815331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
185 W 4TH AVE STE C
Provider Second Line Business Mailing Address:
PHYSICAL THERAPY CENTER OF POST FALLS
Provider Business Mailing Address City Name:
POST FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83854-4979
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-777-8851
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
185 W 4TH AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
POST FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83854-4978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-777-8851
Provider Business Practice Location Address Fax Number:
208-777-8851
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT 266 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 805136200 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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