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General NPI Number Information
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NPI Number | 1609890029
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Entity Type | Organization
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Legal Business Name | DIRKSEN PHYSICAL THERAPY INC PS
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 27 COLWELL STREET
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City | PORT HADLOCK
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State | WA
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Zip | 98339
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Country | US
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Telephone | 360-385-9310
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Fax | 360-379-8826
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Provider Business Mailing Address
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Address Line | PO BOX 897
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City | PORT HADLOCK
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State | WA
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Zip | 98339-0897
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Country | US
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Telephone | 360-385-9310
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Fax | 360-379-8826
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JEANNE DIRKSEN
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Credential | PT
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Telephone | 360-385-9310
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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 |
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License Number State |
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