Provider Demographics
NPI:1578935128
Name:DUPONT PHYSICAL THERAPY, INC., P.S.
Entity Type:Organization
Organization Name:DUPONT PHYSICAL THERAPY, INC., P.S.
Other - Org Name:DUPONT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PROVOZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-338-0181
Mailing Address - Street 1:100 DENNIS ST SW STE B
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6523
Mailing Address - Country:US
Mailing Address - Phone:360-338-0181
Mailing Address - Fax:360-338-0257
Practice Address - Street 1:1525 WILMINGTON DRIVE
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-9999
Practice Address - Country:US
Practice Address - Phone:253-212-9670
Practice Address - Fax:360-338-0257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty