=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457657975
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH CASCADES PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2011
-----------------------------------------------------
Last Update Date | 08/14/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700B OKOMA DR
-----------------------------------------------------
City | OMAK
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98841-9593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-557-4199
-----------------------------------------------------
Fax | 866-299-1497
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700B OKOMA DR
-----------------------------------------------------
City | OMAK
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98841-9593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-557-4199
-----------------------------------------------------
Fax | 866-299-1497
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAL THERAPIST
-----------------------------------------------------
Name | DINA K LUND
-----------------------------------------------------
Credential | P.T., AT/L
-----------------------------------------------------
Telephone | 509-557-4199
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 602995080
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------