Provider Demographics
NPI:1467432088
Name:SKAGIT ISLAND REHABILITATION GROUP
Entity Type:Organization
Organization Name:SKAGIT ISLAND REHABILITATION GROUP
Other - Org Name:COUPEVILLE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/P.T.
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:E
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-293-2417
Mailing Address - Street 1:3001 R AVE
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-4602
Mailing Address - Country:US
Mailing Address - Phone:360-293-2417
Mailing Address - Fax:360-293-2516
Practice Address - Street 1:202 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3420
Practice Address - Country:US
Practice Address - Phone:360-678-1200
Practice Address - Fax:360-678-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7129414Medicaid
WA0201218OtherLABOR & INDUSTRIES
WA0201218OtherLABOR & INDUSTRIES