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General NPI Number Information
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NPI Number | 1215445549
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Entity Type | Organization
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Legal Business Name | INTECORE WA, INC
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Dates
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Enumeration Date | 01/22/2018
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 1550 NE RIDDELL RD STE 170
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City | BREMERTON
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State | WA
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Zip | 98310-3060
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Country | US
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Telephone | 360-474-3274
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Fax | 360-824-6720
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Provider Business Mailing Address
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Address Line | 5050 NE STATE WAY 303 #103-221
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City | BREMERTON
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State | WA
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Zip | 98311
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Country | US
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Telephone | 360-474-3274
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Fax | 360-824-6720
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Authorized Official
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Title or Position | PRESIDENT/PHYSICAL THERAPIST
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Name | MARTIN ANDREW VERTSON
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Credential |
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Telephone | 360-474-3274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 60822534
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License Number State | WA
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