1619245396 NPI number — BAY STREET OASIS PHYSICAL THERAPY LLC

Table of content: (NPI 1619245396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619245396 NPI number — BAY STREET OASIS PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY STREET OASIS PHYSICAL THERAPY LLC
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:
1619245396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 W HOLLY ST
Provider Second Line Business Mailing Address:
SUITE M6
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98225-4361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-676-8077
Provider Business Mailing Address Fax Number:
360-715-8574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 W HOLLY ST
Provider Second Line Business Practice Location Address:
SUITE M6
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-4361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-676-8077
Provider Business Practice Location Address Fax Number:
360-715-8574
Provider Enumeration Date:
12/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
SIDNEY
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
360-676-8077

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  00003537 , 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)

  • Identifier: 7078793 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105059 . This is a "L&I OF WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com