Basic Information
| Provider Information | |||||||||
| NPI: | 1245427830 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CASCADE REHABILITATION, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MUKILTEO CLINIC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11805 N CREEK PKWY S | ||||||||
| Address2: | SUITE 113 | ||||||||
| City: | BOTHELL | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980118803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258065700 | ||||||||
| FaxNumber: | 4258065701 | ||||||||
| Practice Location | |||||||||
| Address1: | 12121 HARBOUR REACH DR | ||||||||
| Address2: | STE 100 | ||||||||
| City: | MUKILTEO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982755314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254938313 | ||||||||
| FaxNumber: | 4254939614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2007 | ||||||||
| LastUpdateDate: | 03/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | BAKER | ||||||||
| AuthorizedOfficialFirstName: | DEBBIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | FINANCE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4258065700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HEALTHFORCE PARTNERS | ||||||||
| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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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.