1912173923 NPI number — CASCADE PHYSICAL THERAPY LLC

Table of content: (NPI 1912173923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912173923 NPI number — CASCADE PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASCADE 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:
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:
1912173923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
406 SE 131ST AVE
Provider Second Line Business Mailing Address:
STE 205B
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98683-4004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-253-4767
Provider Business Mailing Address Fax Number:
360-892-9241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
406 SE 131ST AVE
Provider Second Line Business Practice Location Address:
STE 205B
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98683-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-253-4767
Provider Business Practice Location Address Fax Number:
360-892-9241
Provider Enumeration Date:
04/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COOK
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
360-253-4767

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT00008235 , 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: 807220500 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7125206 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 178532 . This is a "DEPARTMENT OF LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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