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General NPI Number Information
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NPI Number | 1851712202
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Entity Type | Organization
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Legal Business Name | PELVIC REHAB SPECIALISTS
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Dates
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Enumeration Date | 01/02/2014
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Last Update Date | 01/02/2014
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Provider Practice Location Address
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Address Line | 3015 LIMITED LN NW SUITE B
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City | OLYMPIA
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State | WA
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Zip | 98502-2638
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Country | US
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Telephone | 360-709-0700
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Fax | 360-709-0703
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Provider Business Mailing Address
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Address Line | PO BOX 2170
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City | SUMNER
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State | WA
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Zip | 98390-0480
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Country | US
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Telephone | 253-840-2313
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Fax | 253-840-6340
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Authorized Official
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Title or Position | CEO
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Name | MR. RANDALL G. JOHNSON
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Credential | DPT
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Telephone | 253-840-6448
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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 |
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License Number State |
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