1710285531 NPI number — CASCADIA PHYSICAL THERAPY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710285531 NPI number — CASCADIA PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASCADIA PHYSICAL THERAPY
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:
1710285531
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 HARRIS AVE
Provider Second Line Business Mailing Address:
STE.101
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98225-7008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-734-0222
Provider Business Mailing Address Fax Number:
360-734-2990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 HARRIS AVE
Provider Second Line Business Practice Location Address:
STE.101
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-7008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-734-0222
Provider Business Practice Location Address Fax Number:
360-734-2990
Provider Enumeration Date:
03/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HALME
Authorized Official First Name:
AVILIO
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER, PHYSICAL THERAPIST
Authorized Official Telephone Number:
360-734-0222

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  PT00007700 , 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: 7134950 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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