Provider Demographics
NPI:1467505099
Name:PEEPLES PHYSICAL THERAPY AND FITNESS CLINIC INC.
Entity Type:Organization
Organization Name:PEEPLES PHYSICAL THERAPY AND FITNESS CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PEEPLES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-733-5155
Mailing Address - Street 1:1744 IOWA ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-4702
Mailing Address - Country:US
Mailing Address - Phone:360-733-5155
Mailing Address - Fax:360-733-1165
Practice Address - Street 1:1744 IOWA ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-4702
Practice Address - Country:US
Practice Address - Phone:360-733-5155
Practice Address - Fax:360-733-1165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006844225100000X
WA6844261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7136781Medicaid
WA7228792OtherAETNA
WA0206043OtherLABOR & INDUSTRIES
WAG8859335Medicare PIN