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General NPI Number Information
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NPI Number | 1699835645
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY SPECIALISTS, PS
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/17/2010
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Provider Practice Location Address
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Address Line | PHYSICAL THERAPY SPECIALISTS 1152 DOUGLAS ST
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City | LONGVIEW
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State | WA
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Zip | 98632
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Country | US
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Telephone | 360-423-1113
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Fax | 360-423-1115
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Provider Business Mailing Address
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Address Line | PHYSICAL THERAPY SPECIALISTS PO BOX 2369
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City | LONGVIEW
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State | WA
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Zip | 98632
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Country | US
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Telephone | 360-423-1113
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Fax | 360-423-1115
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Authorized Official
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Title or Position | OWNER PHYSICAL THERAPIST
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Name | ROBERT M BONEY
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Credential | MSPT
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Telephone | 360-423-1113
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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 | PT00006372
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License Number State | WA
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