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General NPI Number Information
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NPI Number | 1881881910
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Entity Type | Individual
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Provider Name | HEATHER RUTH PARK-SKOGEN M.P.T.
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Gender | Female
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 220 WEST 1ST AVE
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City | TOPPENISH
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State | WA
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Zip | 98948
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Country | US
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Telephone | 509-865-5650
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Fax |
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Provider Business Mailing Address
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Address Line | 220 W 1ST AVE
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City | TOPPENISH
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State | WA
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Zip | 98948-1526
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Country | US
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Telephone | 509-865-5650
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PT00008016
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License Number State | WA
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