MEDICARE: IRENE PREPULA PT

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	PT00000946	WA
2	225100000X	Physical Therapist	0520	OR

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	:	1639165681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE PREPULA PT

Provider Business Mailing Address
First Line	:	PO BOX 893
Second Line	:
City	:	BATTLE GROUND
State	:	WA
Zip	:	98604-0893
Country	:	US
Telephone Number	:	360-687-5666
Fax Number	:	360-666-8346

Provider Business Practice Location Address
First Line	:	18503 NE 219TH ST
Second Line	:
City	:	BATTLE GROUND
State	:	WA
Zip	:	98604-9282
Country	:	US
Telephone Number	:	360-687-5666
Fax Number	:	360-666-8346

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	06/14/2016

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Directions to “ IRENE PREPULA PT” Practice Location

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