Basic Information
| Provider Information | |||||||||
| NPI: | 1003254772 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RMTS TOPPENISH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 540640 | ||||||||
| Address2: | |||||||||
| City: | NORTH SALT LAKE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840540640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019878700 | ||||||||
| FaxNumber: | 8019878701 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 W 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | TOPPENISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989481615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098653141 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2013 | ||||||||
| LastUpdateDate: | 06/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | WORTLEY | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8019878700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.