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General NPI Number Information
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NPI Number | 1790955201
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Entity Type | Organization
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Legal Business Name | QUAIL RUN PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 13854 STATE ROUTE 23
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City | SAINT JOHN
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State | WA
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Zip | 99171-9756
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Country | US
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Telephone | 509-648-3341
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Fax | 509-648-4237
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Provider Business Mailing Address
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Address Line | PO BOX 66
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City | SAINT JOHN
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State | WA
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Zip | 99171-0066
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Country | US
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Telephone | 509-648-3341
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Fax | 509-648-4237
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. JAMES WILLIAM ROGERS
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Credential | P.T.
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Telephone | 509-648-3341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 3038
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License Number State | WA
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