MEDICARE: ETTA PINKENS, PT, LLC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1962113720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETTA PINKENS, PT, LLC

Provider Business Mailing Address
First Line	:	PO BOX 42
Second Line	:
City	:	CLINTON
State	:	WA
Zip	:	98236-0042
Country	:	US
Telephone Number	:	360-631-3069
Fax Number	:

Provider Business Practice Location Address
First Line	:	6442A CENTRAL AVE
Second Line	:
City	:	CLINTON
State	:	WA
Zip	:	98236-9698
Country	:	US
Telephone Number	:	360-631-3069
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MS. ETTA PINKENS
Credential	:	PT
Telephone Number	:	360-631-3069

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	02/02/2023

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Directions to “ETTA PINKENS, PT, LLC ” Practice Location

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