1871082974 NPI number — QUENGA, HANSON AND PURDUE, P.S., INC.

Table of content: (NPI 1871082974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871082974 NPI number — QUENGA, HANSON AND PURDUE, P.S., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUENGA, HANSON AND PURDUE, P.S., INC.
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:
PHYSICAL THERAPY ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1871082974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7306 STINSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIG HARBOR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98335-1140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-858-3332
Provider Business Mailing Address Fax Number:
253-858-3327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4606 BRIDGEPORT WAY W STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIVERSITY PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-565-3551
Provider Business Practice Location Address Fax Number:
253-565-4535
Provider Enumeration Date:
05/03/2018

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
LARA
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
253-858-3332

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , 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)





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