Healthcare Provider Details

I. General information

NPI: 1194037846
Provider Name (Legal Business Name): ALTIUS PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 07/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 HIGHWAY 20
WINTHROP WA
98862
US

IV. Provider business mailing address

PO BOX 487
WINTHROP WA
98862-0487
US

V. Phone/Fax

Practice location:
  • Phone: 509-341-4011
  • Fax:
Mailing address:
  • Phone: 509-341-4011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT 00003919
License Number StateWA

VIII. Authorized Official

Name: ANDREW NELSON
Title or Position: OWNER
Credential: PT
Phone: 509-341-4011