Provider Demographics
NPI:1245383314
Name:TOPPENISH PHYSICAL THERAPY REHABILITATION CENTER, INC., P.S.
Entity Type:Organization
Organization Name:TOPPENISH PHYSICAL THERAPY REHABILITATION CENTER, INC., P.S.
Other - Org Name:TOPPENISH PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:FUNK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:509-865-3141
Mailing Address - Street 1:501 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-1615
Mailing Address - Country:US
Mailing Address - Phone:509-865-3141
Mailing Address - Fax:509-865-7388
Practice Address - Street 1:501 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1615
Practice Address - Country:US
Practice Address - Phone:509-865-3141
Practice Address - Fax:509-865-7388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0178563OtherLABOR & IND. GROUP #
WA2400OtherGROUP HEALTH GROUP #
WA7123979Medicaid
WA8801020Medicare ID - Type UnspecifiedMEDICARE GROUP #
WA2400OtherGROUP HEALTH GROUP #