MEDICARE: ELLENSBURG PHYSICAL THERAPY CENTER INC

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	PT00003715	WA

General Provider Information

NPI Number	:	1457460123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLENSBURG PHYSICAL THERAPY CENTER INC

Provider Business Mailing Address
First Line	:	4781 COVE ROAD
Second Line	:
City	:	ELLENSBURG
State	:	WA
Zip	:	98926-9135
Country	:	US
Telephone Number	:	509-962-3292
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 N PEARL ST STE K
Second Line	:
City	:	ELLENSBURG
State	:	WA
Zip	:	98926-2938
Country	:	US
Telephone Number	:	509-962-2492
Fax Number	:	509-962-5836

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CHRIS T DUNLOP
Credential	:
Telephone Number	:	509-962-3292

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	10/24/2008

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