MEDICARE: SALLY M AERTS PT, OCS, COMT

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	7659	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598765216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY M AERTS PT, OCS, COMT

Provider Business Mailing Address
First Line	:	637 H STREET
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-6554
Country	:	US
Telephone Number	:	360-774-1534
Fax Number	:

Provider Business Practice Location Address
First Line	:	637 H ST
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-5243
Country	:	US
Telephone Number	:	360-774-1534
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	12/31/2012

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