Healthcare Provider Details

I. General information

NPI: 1437910049
Provider Name (Legal Business Name): PHYSICAL THERAPY & REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 11/28/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 SE 101ST AVE
VANCOUVER WA
98664-3907
US

IV. Provider business mailing address

808 SE CHKALOV DR STE 3 #199
VANCOUVER WA
98683
US

V. Phone/Fax

Practice location:
  • Phone: 503-208-4130
  • Fax: 503-961-1228
Mailing address:
  • Phone: 503-208-4130
  • Fax: 503-961-1228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAVID PAVLOVICH VERGULYANETS
Title or Position: MEMBER
Credential: DPT
Phone: 503-208-4130