MEDICARE: WHITE PINE PHYSICAL THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1033897962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE PINE PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	4617 CHARDONNAY LN NE APT 101
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-1364
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4617 CHARDONNAY LN NE APT 101
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-1364
Country	:	US
Telephone Number	:	206-552-8670
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANNIE CUMMING
Credential	:	DPT
Telephone Number	:	206-331-2481

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	07/10/2023

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