Healthcare Provider Details

I. General information

NPI: 1639178361
Provider Name (Legal Business Name): DANIEL ARTHUR CHURCHES P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 CAPITAL MALL DR SW STE D
OLYMPIA WA
98502-8654
US

IV. Provider business mailing address

PO BOX 368
OLYMPIA WA
98507-0368
US

V. Phone/Fax

Practice location:
  • Phone: 360-709-6221
  • Fax: 360-359-4727
Mailing address:
  • Phone: 360-709-6221
  • Fax: 360-359-4727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00005833
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT00005833 WA
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT00005833 WA
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: