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General NPI Number Information
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NPI Number | 1952182586
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Entity Type | Organization
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Legal Business Name | SHALOM'S PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 10/10/2023
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 114 VISTA WAY
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City | KENNEWICK
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State | WA
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Zip | 99336-3119
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Country | US
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Telephone | 509-528-6918
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Fax |
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Provider Business Mailing Address
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Address Line | 1524 S JEFFERSON PL
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City | KENNEWICK
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State | WA
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Zip | 99338-2182
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Country | US
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Telephone | 509-528-6918
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANI'EL SHALOM POWELL
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Credential | DPT
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Telephone | 509-528-6918
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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 |
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License Number State |
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