Basic Information
| Provider Information | |||||||||
| NPI: | 1770034837 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PUGET SOUND HEALTH & REHAB, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ONPOINT PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5718 | ||||||||
| Address2: | |||||||||
| City: | KALISPELL | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599035718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8554567146 | ||||||||
| FaxNumber: | 4063092579 | ||||||||
| Practice Location | |||||||||
| Address1: | 13215 SE 240TH ST STE D | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980425120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536313026 | ||||||||
| FaxNumber: | 2536313899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2016 | ||||||||
| LastUpdateDate: | 07/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | STIMAC | ||||||||
| AuthorizedOfficialFirstName: | BLAINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO, MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4067561128 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | 07/17/2020 | ||||||||
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.