Healthcare Provider Details

I. General information

NPI: 1235173576
Provider Name (Legal Business Name): FAMILYCARE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11042 STATE ROUTE 525 #106
CLINTON WA
98236-8618
US

IV. Provider business mailing address

11042 STATE ROUTE 525 #106
CLINTON WA
98236-8618
US

V. Phone/Fax

Practice location:
  • Phone: 360-331-7850
  • Fax: 360-331-4114
Mailing address:
  • Phone: 360-331-7850
  • Fax: 360-331-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PENNY SWEARENGIN
Title or Position: GENERAL ADMINISTRATOR
Credential:
Phone: 360-331-7850