=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174451124
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROACTIVE PHYSICAL THERAPY WENATCHEE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2026
-----------------------------------------------------
Last Update Date | 05/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 5TH ST STE 150
-----------------------------------------------------
City | WENATCHEE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98801-6649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-630-6591
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 183 SUMMER RIDGE LN
-----------------------------------------------------
City | MALAGA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98828-9606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-630-6591
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CARMEN GAIL DOOLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 509-630-6591
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------