Healthcare Provider Details

I. General information

NPI: 1740261791
Provider Name (Legal Business Name): LAKE CHELAN PHYSICAL THERAPY, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 METHOW VALLEY HIGHWAY
TWISP WA
98856
US

IV. Provider business mailing address

PO BOX 870
TWISP WA
98856-0870
US

V. Phone/Fax

Practice location:
  • Phone: 509-997-4851
  • Fax: 509-997-4852
Mailing address:
  • Phone: 509-997-4851
  • Fax: 509-997-4852

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: BRENDA TAYLOR
Title or Position: BOOKKEEPER
Credential:
Phone: 509-682-4713