Provider Demographics
NPI:1326356585
Name:VALLEY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:VALLEY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:TUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:509-529-3220
Mailing Address - Street 1:1017 S 2ND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4183
Mailing Address - Country:US
Mailing Address - Phone:509-529-3220
Mailing Address - Fax:509-522-3886
Practice Address - Street 1:1017 S 2ND AVE STE 1
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4183
Practice Address - Country:US
Practice Address - Phone:509-529-3220
Practice Address - Fax:509-522-3886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT0003096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA650008497OtherRAILROAD MEDICARE
WA7060916Medicaid
WA650008497OtherRAILROAD MEDICARE