Provider Demographics
NPI:1598042632
Name:BELLINGHAM SPORTS AND SPINE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BELLINGHAM SPORTS AND SPINE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:BOHN
Authorized Official - Suffix:
Authorized Official - Credentials:PT,OCS,COMT,FAAOMPT
Authorized Official - Phone:360-303-8044
Mailing Address - Street 1:1815 C ST
Mailing Address - Street 2:SUITE J36
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4027
Mailing Address - Country:US
Mailing Address - Phone:360-303-8044
Mailing Address - Fax:
Practice Address - Street 1:1815 C ST
Practice Address - Street 2:SUITE J36
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4027
Practice Address - Country:US
Practice Address - Phone:360-303-8044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 00003493261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2040708Medicaid
WAG8891851Medicare PIN