Provider Demographics
NPI:1437910049
Name:PHYSICAL THERAPY & REHAB
Entity Type:Organization
Organization Name:PHYSICAL THERAPY & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAVLOVICH
Authorized Official - Last Name:VERGULYANETS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:503-208-4130
Mailing Address - Street 1:305 SE CHKALOV DR STE 111 #199
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683
Mailing Address - Country:US
Mailing Address - Phone:503-208-4130
Mailing Address - Fax:503-961-1228
Practice Address - Street 1:109 SE 101ST AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3907
Practice Address - Country:US
Practice Address - Phone:503-208-4130
Practice Address - Fax:503-961-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation