Healthcare Provider Details

I. General information

NPI: 1295066140
Provider Name (Legal Business Name): NEW ATHLETE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 NE HIGHWAY 99 SUITE 101
VANCOUVER WA
98665-8878
US

IV. Provider business mailing address

7219 NE HIGHWAY 99 SUITE 101
VANCOUVER WA
98665
US

V. Phone/Fax

Practice location:
  • Phone: 360-567-0553
  • Fax: 360-258-1531
Mailing address:
  • Phone: 360-567-0553
  • Fax: 360-258-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number StateMN

VIII. Authorized Official

Name: MR. RYAN EVERETT PAUL
Title or Position: OWNER
Credential: ARP THERAPIST
Phone: 360-567-0553