Healthcare Provider Details

I. General information

NPI: 1174765523
Provider Name (Legal Business Name): SUMMIT PACIFIC REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 HARRISON AVE
CENTRALIA WA
98531-4568
US

IV. Provider business mailing address

970 5TH AVE NW SUITE 7
ISSAQUAH WA
98027-2469
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-0112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: AMY MANNING
Title or Position: PTA
Credential:
Phone: 360-740-5192