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General NPI Number Information
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NPI Number | 1700054186
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Entity Type | Organization
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Legal Business Name | EAGLE ROCK PHYSICAL THERAPY, PS
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 11/12/2018
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Provider Practice Location Address
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Address Line | 411 HOSPITAL WAY
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City | BREWSTER
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State | WA
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Zip | 98812
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Country | US
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Telephone | 509-689-4301
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Fax | 509-689-4307
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Provider Business Mailing Address
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Address Line | PO BOX 769 411 HOSPITAL WAY
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City | BREWSTER
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State | WA
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Zip | 98812-0769
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Country | US
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Telephone | 509-689-4301
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Fax | 509-689-4307
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHAWN ISENHART
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Credential | DPT
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Telephone | 509-689-4301
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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 | PT00003294
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License Number State | WA
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