Provider Demographics
NPI:1497102792
Name:SKAGIT ISLAND REHABILITATION GROUP LLC
Entity Type:Organization
Organization Name:SKAGIT ISLAND REHABILITATION GROUP LLC
Other - Org Name:OAK HARBOR PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PT
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:360-299-2781
Mailing Address - Street 1:3001 R AVE
Mailing Address - Street 2:SUITE 210D
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:
Practice Address - Street 1:632 ERIN PARK RD
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-2705
Practice Address - Country:US
Practice Address - Phone:360-293-2417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty