Basic Information
| Provider Information | |||||||||
| NPI: | 1215324835 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHIDBEY PERFORMANCE PHYSICAL THERAPY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3482 | ||||||||
| Address2: | |||||||||
| City: | POST FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838773482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082096170 | ||||||||
| FaxNumber: | 2082096169 | ||||||||
| Practice Location | |||||||||
| Address1: | 5575 HARBOR AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | FREELAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982490000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603310141 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2015 | ||||||||
| LastUpdateDate: | 04/21/2015 | ||||||||
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| AuthorizedOfficialLastName: | LEITZ | ||||||||
| AuthorizedOfficialFirstName: | ISAAC | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4252811280 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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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.