MEDICARE: OASIS 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	602145077	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0151973	OTHER	WA	WA LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1558419135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OASIS PHYSICAL THERAPY, PLLC

Provider Business Mailing Address
First Line	:	6825 BURDEN BLVD STE D
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99301-5633
Country	:	US
Telephone Number	:	509-416-0444
Fax Number	:	509-545-1112

Provider Business Practice Location Address
First Line	:	6825 BURDEN BLVD STE D
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99301-5633
Country	:	US
Telephone Number	:	509-416-0444
Fax Number	:	509-545-1112

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MONICA L MOHL
Credential	:
Telephone Number	:	509-416-0444

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	02/27/2017

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