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General NPI Number Information
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NPI Number | 1558509786
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Entity Type | Organization
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Legal Business Name | BONNEY LAKE PHYSICAL THERAPY AND HAND REHAB, PLLC
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Dates
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Enumeration Date | 01/26/2009
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Last Update Date | 01/19/2015
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Provider Practice Location Address
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Address Line | 20910 STATE ROUTE 410 E
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City | BONNEY LAKE
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State | WA
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Zip | 98391-6302
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Country | US
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Telephone | 253-862-2575
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Fax | 253-862-2675
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Provider Business Mailing Address
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Address Line | 20910 STATE ROUTE 410 E
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City | BONNEY LAKE
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State | WA
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Zip | 98391-6302
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Country | US
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Telephone | 253-862-2575
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Fax | 253-862-2675
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL ANDREW EGBERT
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Credential | PT
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Telephone | 253-862-2575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT5418
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | OT2499
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | OT2499
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT5418
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License Number State | WA
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