Provider Demographics
NPI:1225212665
Name:VORIS, VONNIE JO (PT)
Entity Type:Individual
Prefix:MS
First Name:VONNIE
Middle Name:JO
Last Name:VORIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 572
Mailing Address - Street 2:
Mailing Address - City:CARLSBORG
Mailing Address - State:WA
Mailing Address - Zip Code:98324-0572
Mailing Address - Country:US
Mailing Address - Phone:360-683-6101
Mailing Address - Fax:360-683-6102
Practice Address - Street 1:865 CARLSBORG RD
Practice Address - Street 2:SUITE C
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-8390
Practice Address - Country:US
Practice Address - Phone:360-683-6101
Practice Address - Fax:360-683-6102
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000037592251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9056763OtherDSHS / DME GROUP #
WA8324568OtherDSHS / DME
WA0160256OtherLABOR & INDUSTRIES
WA4865240001OtherDMERC
WA8324568Medicaid
WA9259LOOtherREGENCE BLUE SHIELD
WA0160256OtherLABOR & INDUSTRIES
WA8324568OtherDSHS / DME