=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801554506
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH APONIK MPT, OCS, CMPT, ATC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2021
-----------------------------------------------------
Last Update Date | 11/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 817 COMMERCIAL ST
-----------------------------------------------------
City | LEAVENWORTH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98826-1316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-548-3421
-----------------------------------------------------
Fax | 509-548-2511
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11642 RIVER BEND DR
-----------------------------------------------------
City | LEAVENWORTH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98826-9353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-433-1505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 8067
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------