Basic Information
| Provider Information | |||||||||
| NPI: | 1023389764 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YELM PHYSICAL THERAPY, PLLC | ||||||||
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| OtherOrganizationName: | YELM PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 514 W YELM AVE | ||||||||
| Address2: | |||||||||
| City: | YELM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985977679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604582444 | ||||||||
| FaxNumber: | 3604582747 | ||||||||
| Practice Location | |||||||||
| Address1: | 514 W YELM AVE | ||||||||
| Address2: | |||||||||
| City: | YELM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985977679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604582444 | ||||||||
| FaxNumber: | 3604582747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2012 | ||||||||
| LastUpdateDate: | 07/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | SIPE | ||||||||
| AuthorizedOfficialFirstName: | SEAN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3609510754 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MPT SCS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00007854 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.