MEDICARE: WHATCOM COMMUNITY PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1083187389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHATCOM COMMUNITY PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	143 W KELLOGG RD
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-8009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	143 W KELLOGG RD
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-8009
Country	:	US
Telephone Number	:	623-341-1779
Fax Number	:

Authorized Official
Title or Position	:	DPT, OWNER
Name	:	PAUL FITZGERALD
Credential	:	DPT
Telephone Number	:	623-341-1779

Provider Enumeration Date	:	01/09/2019
Last Update Date	:	01/22/2019

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Directions to “WHATCOM COMMUNITY PHYSICAL THERAPY ” Practice Location

Language	Start Address	Practice Location

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