Healthcare Provider Details

I. General information

NPI: 1225230980
Provider Name (Legal Business Name): COLUMBIA BASIN PHYSICAL THERAPY INC. PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 BASIN ST SW
EPHRATA WA
98823-2041
US

IV. Provider business mailing address

1075 BASIN ST SW
EPHRATA WA
98823-2041
US

V. Phone/Fax

Practice location:
  • Phone: 509-754-4510
  • Fax: 509-754-2162
Mailing address:
  • Phone: 509-754-4510
  • Fax: 509-754-2162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License NumberPT00002721
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number StateUT

VIII. Authorized Official

Name: DALE S. NELSON
Title or Position: PRESIDENT
Credential: PT
Phone: 509-754-4510