Basic Information
| Provider Information | |||||||||
| NPI: | 1376096008 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL HAND THERAPY, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1458 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984011458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099621132 | ||||||||
| FaxNumber: | 8663655203 | ||||||||
| Practice Location | |||||||||
| Address1: | 2323 W BROADWAY AVE | ||||||||
| Address2: | UNIT 5 | ||||||||
| City: | MOSES LAKE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988372676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003535208 | ||||||||
| FaxNumber: | 8663655203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2016 | ||||||||
| LastUpdateDate: | 07/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | RATTRAY | ||||||||
| AuthorizedOfficialFirstName: | JARED | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5099621132 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CENTRAL HAND THERAPY, PC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | OTR-L | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 7682594 | 05 | WA | MEDICAID |