Provider Demographics
NPI:1457657975
Name:NORTH CASCADES PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:NORTH CASCADES PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:PT, AT/L
Authorized Official - Phone:509-557-4199
Mailing Address - Street 1:700B OKOMA DR
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-9593
Mailing Address - Country:US
Mailing Address - Phone:509-557-4199
Mailing Address - Fax:866-299-1497
Practice Address - Street 1:700B OKOMA DR
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9593
Practice Address - Country:US
Practice Address - Phone:509-557-4199
Practice Address - Fax:866-299-1497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602995080261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0260667OtherLABOR AND INDUSTRIES
WAG8934909OtherMEDICARE
WA1528086899OtherDSHS