Healthcare Provider Details

I. General information

NPI: 1528200664
Provider Name (Legal Business Name): PAULA FRIES DYKEMA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA SUE FRIES DPT

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 NE 139TH ST STE 325
VANCOUVER WA
98686-2319
US

IV. Provider business mailing address

200 NE MOTHER JOSEPH PL STE 210
VANCOUVER WA
98664-3295
US

V. Phone/Fax

Practice location:
  • Phone: 360-254-6161
  • Fax: 360-449-1146
Mailing address:
  • Phone: 360-254-6161
  • Fax: 360-449-1146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60788673
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: