Provider Demographics
NPI:1043521206
Name:SAN JUAN PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:SAN JUAN PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAMMIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-378-4112
Mailing Address - Street 1:PO BOX 1845
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-1845
Mailing Address - Country:US
Mailing Address - Phone:360-378-4112
Mailing Address - Fax:360-378-4655
Practice Address - Street 1:689-A AIRPORT CENTER ROAD
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250
Practice Address - Country:US
Practice Address - Phone:360-378-4112
Practice Address - Fax:360-378-4655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty