Basic Information
Provider Information | |||||||||
NPI: | 1619164209 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CASCADE REHABILITATION | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | COLBY REHAB | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
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: | 3726 BROADWAY | ||||||||
Address2: | STE 104 | ||||||||
City: | EVERETT | ||||||||
State: | WA | ||||||||
PostalCode: | 982013787 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4252524600 | ||||||||
FaxNumber: | 4252524477 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/27/2007 | ||||||||
LastUpdateDate: | 05/20/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BAKER | ||||||||
AuthorizedOfficialFirstName: | DEBBIE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | FINANCE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 4258065700 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | HEALTHFORCE PARTNERS | ||||||||
AuthorizedOfficialNamePrefix: | MISS | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
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.