Provider Demographics
NPI:1407820103
Name:ARIAS, GEORGE A (MSPT)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:A
Last Name:ARIAS
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 W TIETAN ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362
Mailing Address - Country:US
Mailing Address - Phone:509-522-0114
Mailing Address - Fax:509-522-9868
Practice Address - Street 1:275 W TIETAN ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362
Practice Address - Country:US
Practice Address - Phone:509-522-0114
Practice Address - Fax:509-522-9868
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7139611Medicaid
WA0224515OtherL & I
OR159057Medicaid
WA0224515OtherL & I
WAS24854Medicare UPIN