Provider Demographics
NPI:1225230980
Name:COLUMBIA BASIN PHYSICAL THERAPY INC. PS
Entity Type:Organization
Organization Name:COLUMBIA BASIN PHYSICAL THERAPY INC. PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:S
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:509-754-4510
Mailing Address - Street 1:1075 BASIN ST SW
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-2041
Mailing Address - Country:US
Mailing Address - Phone:509-754-4510
Mailing Address - Fax:509-754-2162
Practice Address - Street 1:1075 BASIN ST SW
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-2041
Practice Address - Country:US
Practice Address - Phone:509-754-4510
Practice Address - Fax:509-754-2162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
273Y00000X
WAPT00002721273Y00000X
UT273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7105174Medicaid