Provider Demographics
NPI:1407270259
Name:HOODSPORT PHYSICAL THERAPY
Entity Type:Organization
Organization Name:HOODSPORT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:AYRES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-877-2065
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:HOODSPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98548-1430
Mailing Address - Country:US
Mailing Address - Phone:360-877-2065
Mailing Address - Fax:360-877-2064
Practice Address - Street 1:60 NORTH LAKE CUSHMAN ROAD
Practice Address - Street 2:STE 107
Practice Address - City:HOODSPORT
Practice Address - State:WA
Practice Address - Zip Code:98548
Practice Address - Country:US
Practice Address - Phone:360-877-2065
Practice Address - Fax:360-877-2064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty