MEDICARE: MR. DANIEL ARTHUR CHURCHES P.T.

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	PT00005833	WA
2	2251X0800X	Orthopedic Physical Therapist	PT00005833 WA	WA
3	2251S0007X	Sports Physical Therapist	PT00005833 WA	WA

General Provider Information

NPI Number	:	1639178361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL ARTHUR CHURCHES P.T.

Provider Business Mailing Address
First Line	:	PO BOX 368
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98507-0368
Country	:	US
Telephone Number	:	360-709-6221
Fax Number	:	360-359-4727

Provider Business Practice Location Address
First Line	:	3901 CAPITAL MALL DR SW
Second Line	:	STE D
City	:	OLYMPIA
State	:	WA
Zip	:	98502-8654
Country	:	US
Telephone Number	:	360-709-6221
Fax Number	:	360-359-4727

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	12/16/2014

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