Provider Demographics
NPI:1073942488
Name:FERNDALE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:FERNDALE PHYSICAL THERAPY
Other - Org Name:WHATCOM PHYSICAL THERAPY INC PS DBA FERNDALE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-332-8167
Mailing Address - Street 1:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98231-0120
Mailing Address - Country:US
Mailing Address - Phone:360-384-5171
Mailing Address - Fax:360-384-0350
Practice Address - Street 1:5603 3RD STREET
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-8394
Practice Address - Country:US
Practice Address - Phone:360-384-5171
Practice Address - Fax:360-384-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB19949Medicare PIN