Basic Information
| Provider Information | |||||||||
| NPI: | 1114542917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COONROD | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | |||||||||
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| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | HARRINGTON | ||||||||
| OtherFirstName: | BRITTANY | ||||||||
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| OtherCredential: | PT, DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1443 W GOODLANDER RD | ||||||||
| Address2: | |||||||||
| City: | SELAH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989428759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243162610 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1608 S 24TH AVE | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989025771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092486113 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2020 | ||||||||
| LastUpdateDate: | 06/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT60489983 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.