Healthcare Provider Details

I. General information

NPI: 1083711253
Provider Name (Legal Business Name): MONTESANO PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 E PIONEER AVE
MONTESANO WA
98563-4606
US

IV. Provider business mailing address

PO BOX 559
MCCLEARY WA
98557-0559
US

V. Phone/Fax

Practice location:
  • Phone: 360-249-4185
  • Fax: 360-249-4195
Mailing address:
  • Phone: 360-249-4185
  • Fax: 360-249-4195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOE W ARNDT
Title or Position: OWNER
Credential: P.T.
Phone: 360-249-4185