Provider Demographics
NPI:1396862652
Name:NW CMW, P.S
Entity Type:Organization
Organization Name:NW CMW, P.S
Other - Org Name:CLINIC OF ORTHOPAEDIC AND SPORTS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CAMARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:253-752-1070
Mailing Address - Street 1:2420 S UNION AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1322
Mailing Address - Country:US
Mailing Address - Phone:253-752-0107
Mailing Address - Fax:253-752-2315
Practice Address - Street 1:2420 S UNION AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1322
Practice Address - Country:US
Practice Address - Phone:253-752-0107
Practice Address - Fax:253-752-2315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7177405Medicaid
WAG8857355Medicare ID - Type Unspecified