Provider Demographics
NPI:1467140921
Name:POULSBO PHYSICAL THERAPY
Entity Type:Organization
Organization Name:POULSBO PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:COREY
Authorized Official - Last Name:TOUCHETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:360-598-2722
Mailing Address - Street 1:1040 NE HOSTMARK ST STE 100E
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7337
Mailing Address - Country:US
Mailing Address - Phone:360-598-2722
Mailing Address - Fax:360-598-2723
Practice Address - Street 1:1040 NE HOSTMARK ST
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7337
Practice Address - Country:US
Practice Address - Phone:206-889-9933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2024-03-27
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
WA1568095644Medicaid