Basic Information
| Provider Information | |||||||||
| NPI: | 1275988206 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YAKIMA VALLEY MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2811 TIETON DR | ||||||||
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| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095758000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1470 N 16TH AVE | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989021381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095746050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2016 | ||||||||
| LastUpdateDate: | 04/27/2016 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | REHAB DEPARTMENT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5095746015 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | DPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | PT60093439 | WA | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.