Healthcare Provider Details

I. General information

NPI: 1992192231
Provider Name (Legal Business Name): STARGAIT PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 07/21/2022
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 NE 47TH ST
VANCOUVER WA
98661
US

IV. Provider business mailing address

16420 SE MCGILLIVRAY BLVD STE 103-355
VANCOUVER WA
98683-3461
US

V. Phone/Fax

Practice location:
  • Phone: 360-356-6811
  • Fax: 855-840-8203
Mailing address:
  • Phone: 541-292-4244
  • Fax: 855-840-8203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT60013093
License Number StateWA

VIII. Authorized Official

Name: MRS. DENISE A WENTZEL
Title or Position: OWNER / CEO
Credential: PT
Phone: 360-356-6811