Provider Demographics
NPI:1457460123
Name:ELLENSBURG PHYSICAL THERAPY CENTER INC
Entity Type:Organization
Organization Name:ELLENSBURG PHYSICAL THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:T
Authorized Official - Last Name:DUNLOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-962-3292
Mailing Address - Street 1:4781 COVE ROAD
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-9135
Mailing Address - Country:US
Mailing Address - Phone:509-962-3292
Mailing Address - Fax:
Practice Address - Street 1:707 N PEARL ST STE K
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-2938
Practice Address - Country:US
Practice Address - Phone:509-962-2492
Practice Address - Fax:509-962-5836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB08612Medicare PIN
WAAB08614Medicare ID - Type Unspecified