Basic Information
| Provider Information | |||||||||
| NPI: | 1720175219 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST GARLAND PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11009 | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985081009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603522037 | ||||||||
| FaxNumber: | 3603520637 | ||||||||
| Practice Location | |||||||||
| Address1: | 1403 W GARLAND AVE STE B | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992052619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093252992 | ||||||||
| FaxNumber: | 5093265112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 01/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | HYATT | ||||||||
| AuthorizedOfficialFirstName: | DENIS | ||||||||
| AuthorizedOfficialMiddleName: | DEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3603522037 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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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 | 7230063 | 05 | WA | MEDICAID | HY3445 | 01 | WA | REGENCE RIDER | OTHER | 0059965 | 01 | WA | L&I | OTHER |