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General NPI Number Information
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NPI Number | 1578640124
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Entity Type | Organization
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Legal Business Name | WOODLAND CREEK PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 5205 CORPORATE CENTER CT SE SUITE C
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City | LACEY
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State | WA
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Zip | 98503-5901
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Country | US
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Telephone | 360-412-1367
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Fax | 360-412-1391
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Provider Business Mailing Address
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Address Line | 5205 CORPORATE CENTER CT SE SUITE C
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City | LACEY
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State | WA
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Zip | 98503-5901
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Country | US
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Telephone | 360-412-1368
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Fax | 360-412-1391
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Authorized Official
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Title or Position | OWNER
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Name | MR. SCOTT O. ENSIGN
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Credential | MPT, JSCC
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Telephone | 360-412-1367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 602 027 552
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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