Healthcare Provider Details

I. General information

NPI: 1861654824
Provider Name (Legal Business Name): WASHINGTON PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 WEST ROBERT BUSH DRIVE
SOUTH BEND WA
98586
US

IV. Provider business mailing address

PO BOX 211
SOUTH BEND WA
98586-0211
US

V. Phone/Fax

Practice location:
  • Phone: 360-875-5543
  • Fax: 360-875-5544
Mailing address:
  • Phone: 360-875-5543
  • Fax: 360-875-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT00003050
License Number StateWA

VIII. Authorized Official

Name: ERNEST D GEIGER
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 360-875-5543