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General NPI Number Information
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NPI Number | 1255354270
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Entity Type | Organization
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Legal Business Name | OUT REACH MOBILE IMAGING
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11012 CANYON RD E STE 8
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City | PUYALLUP
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State | WA
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Zip | 98373-4200
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Country | US
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Telephone | 253-921-6613
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Fax | 253-435-1933
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Provider Business Mailing Address
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Address Line | 11012 CANYON RD E STE 8
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City | PUYALLUP
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State | WA
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Zip | 98373-4200
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Country | US
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Telephone | 253-921-6613
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Fax | 253-435-1933
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Authorized Official
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Title or Position | OWNER
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Name | THERESA M TREBILCOCK
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Credential | RDMS, RDCS
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Telephone | 253-921-6613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number | 19683
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License Number State | WA
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