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General NPI Number Information
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NPI Number | 1083748040
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Entity Type | Organization
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Legal Business Name | PORT TOWNSEND ORTHOPAEDICS & SPORTS MEDICINE, PLLC
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1274 7TH ST STE A
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City | PORT TOWNSEND
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State | WA
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Zip | 98368-2404
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Country | US
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Telephone | 360-981-3812
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2658
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City | POULSBO
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State | WA
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Zip | 98370-2658
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Country | US
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Telephone | 360-981-3812
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. KERRY EILEEN COX
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Credential |
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Telephone | 360-981-3812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD00032312
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License Number State | WA
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