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General NPI Number Information
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NPI Number | 1215218102
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Entity Type | Organization
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Legal Business Name | TIMBERLINE REHABILITATION SERVICES, PS
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Dates
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Enumeration Date | 09/06/2011
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Last Update Date | 09/06/2011
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Provider Practice Location Address
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Address Line | 920 NE 112TH AVENUE SUITE 103
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City | VANCOUVER
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State | WA
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Zip | 98684-5104
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Country | US
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Telephone | 360-567-2002
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Fax | 360-567-2005
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Provider Business Mailing Address
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Address Line | 920 NE 112TH AV SUITE 103
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City | VANCOUVER
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State | WA
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Zip | 98684-5104
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Country | US
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Telephone | 360-567-2002
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Fax | 360-567-2005
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Authorized Official
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Title or Position | M.P.T.
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Name | MR. ZANE A. SMITH
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Credential | CEO
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Telephone | 360-567-2002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD00043000
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License Number State | WA
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