Provider Demographics
NPI:1376096008
Name:CENTRAL HAND THERAPY, PC
Entity Type:Organization
Organization Name:CENTRAL HAND THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:RATTRAY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR-L
Authorized Official - Phone:509-962-1132
Mailing Address - Street 1:PO BOX 1458
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1458
Mailing Address - Country:US
Mailing Address - Phone:509-962-1132
Mailing Address - Fax:866-365-5203
Practice Address - Street 1:2323 W BROADWAY AVE
Practice Address - Street 2:UNIT 5
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2676
Practice Address - Country:US
Practice Address - Phone:800-353-5208
Practice Address - Fax:866-365-5203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL HAND THERAPY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7682594Medicaid
WAG8911536Medicare PIN