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General NPI Number Information
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NPI Number | 1720247877
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Entity Type | Organization
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Legal Business Name | VANCOUVER SPINE & ORTHOPEDIC REHABILITION CENTER, PLLC
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Dates
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Enumeration Date | 06/04/2008
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 11802 NE 65TH ST
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City | VANCOUVER
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State | WA
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Zip | 98662-5521
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Country | US
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Telephone | 360-253-6883
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Fax |
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Provider Business Mailing Address
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Address Line | 11802 NE 65TH ST # 100
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City | VANCOUVER
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State | WA
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Zip | 98662-5521
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Country | US
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Telephone | 360-253-6883
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KRISTI WAGGONER
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Credential |
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Telephone | 360-253-6883
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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 | PT00006628
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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 | CH00002774
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License Number State | WA
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