MEDICARE: FAMILYCARE 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	CG9849	OTHER	WA	RAILROAD RETIREMENT GROUP
3	0130162	OTHER	WA	DEPT. OF LABOR GROUP #

General Provider Information

NPI Number	:	1235173576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILYCARE PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	11042 STATE ROUTE 525
Second Line	:	#106
City	:	CLINTON
State	:	WA
Zip	:	98236-8618
Country	:	US
Telephone Number	:	360-331-7850
Fax Number	:	360-331-4114

Provider Business Practice Location Address
First Line	:	11042 STATE ROUTE 525
Second Line	:	#106
City	:	CLINTON
State	:	WA
Zip	:	98236-8618
Country	:	US
Telephone Number	:	360-331-7850
Fax Number	:	360-331-4114

Authorized Official
Title or Position	:	GENERAL ADMINISTRATOR
Name	:	PENNY SWEARENGIN
Credential	:
Telephone Number	:	360-331-7850

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	08/22/2020

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Directions to “FAMILYCARE PHYSICAL THERAPY ” Practice Location

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