Provider Demographics
NPI:1134284060
Name:PT NORTHWEST OF LONGVIEW INC
Entity Type:Organization
Organization Name:PT NORTHWEST OF LONGVIEW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:360-423-9535
Mailing Address - Street 1:1560 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3229
Mailing Address - Country:US
Mailing Address - Phone:360-423-9535
Mailing Address - Fax:360-414-9284
Practice Address - Street 1:20 COWLITZ
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:WA
Practice Address - Zip Code:98611
Practice Address - Country:US
Practice Address - Phone:360-274-4550
Practice Address - Fax:360-274-4548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADC3748OtherMEDICARE RAILROAD
WA7072184Medicaid
WADC3748OtherMEDICARE RAILROAD