Healthcare Provider Details

I. General information

NPI: 1124209838
Provider Name (Legal Business Name): COLUMBIA REHAB AND PAIN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6917 W GRANDRIDGE BLVD STE B
KENNEWICK WA
99336
US

IV. Provider business mailing address

6917 W GRANDRIDGE BLVD STE B
KENNEWICK WA
99336
US

V. Phone/Fax

Practice location:
  • Phone: 509-627-2848
  • Fax: 509-627-2849
Mailing address:
  • Phone: 509-627-2848
  • Fax: 509-627-2849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberMD00041323
License Number StateWA

VIII. Authorized Official

Name: MRS. JEAN YOU
Title or Position: PHYSICIAN
Credential: MD
Phone: 509-627-2848