Provider Demographics
NPI:1265676084
Name:SKYLINE PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:SKYLINE PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:I
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, SCD, OCS, COMT
Authorized Official - Phone:360-738-4300
Mailing Address - Street 1:1408 N GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4507
Mailing Address - Country:US
Mailing Address - Phone:360-738-4300
Mailing Address - Fax:360-738-8010
Practice Address - Street 1:1408 N GARDEN ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4507
Practice Address - Country:US
Practice Address - Phone:360-738-4300
Practice Address - Fax:360-738-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602902030261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy