Provider Demographics
NPI:1437196771
Name:CENTRAL WASHINGTON PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CENTRAL WASHINGTON PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:509-469-7474
Mailing Address - Street 1:1127 TIETON DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3851
Mailing Address - Country:US
Mailing Address - Phone:509-469-7474
Mailing Address - Fax:509-469-7575
Practice Address - Street 1:1127 TIETON DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3851
Practice Address - Country:US
Practice Address - Phone:509-469-7474
Practice Address - Fax:509-469-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA141704OtherLABOR & INDUSTRIES
WA7097827Medicaid
WA7097827Medicaid