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General NPI Number Information
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NPI Number | 1710058581
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Entity Type | Organization
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Legal Business Name | COMSTOCK PHYSICAL THERAPY
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 165 LILLY RD NE SUITE B
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City | OLYMPIA
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State | WA
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Zip | 98506-5028
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Country | US
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Telephone | 360-455-8014
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Fax | 360-455-8719
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Provider Business Mailing Address
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Address Line | 165 LILLY RD NE SUITE B
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City | OLYMPIA
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State | WA
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Zip | 98506-5028
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Country | US
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Telephone | 360-455-8014
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Fax | 360-455-8719
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | LINNEA SINGLETON COMSTOCK
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Credential | PT
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Telephone | 360-455-8014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 602095157
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 602095157
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License Number State | WA
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