Provider Demographics
NPI:1235173576
Name:FAMILYCARE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:FAMILYCARE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEARENGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-331-7850
Mailing Address - Street 1:11042 STATE ROUTE 525
Mailing Address - Street 2:#106
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236-8618
Mailing Address - Country:US
Mailing Address - Phone:360-331-7850
Mailing Address - Fax:360-331-4114
Practice Address - Street 1:11042 STATE ROUTE 525
Practice Address - Street 2:#106
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236-8618
Practice Address - Country:US
Practice Address - Phone:360-331-7850
Practice Address - Fax:360-331-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
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
WA7084700Medicaid
WACG9849OtherRAILROAD RETIREMENT GROUP
WA0130162OtherDEPT. OF LABOR GROUP #
WAGAB10681Medicare ID - Type UnspecifiedMEDICARE GROUP ID