Healthcare Provider Details

I. General information

NPI: 1609890029
Provider Name (Legal Business Name): DIRKSEN PHYSICAL THERAPY INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 COLWELL STREET
PORT HADLOCK WA
98339
US

IV. Provider business mailing address

PO BOX 897
PORT HADLOCK WA
98339-0897
US

V. Phone/Fax

Practice location:
  • Phone: 360-385-9310
  • Fax: 360-379-8826
Mailing address:
  • Phone: 360-385-9310
  • Fax: 360-379-8826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. JEANNE DIRKSEN
Title or Position: OWNER
Credential: PT
Phone: 360-385-9310