Provider Demographics
NPI:1598765216
Name:AERTS, SALLY M (PT, OCS, COMT)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:M
Last Name:AERTS
Suffix:
Gender:F
Credentials:PT, OCS, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 H STREET
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-6554
Mailing Address - Country:US
Mailing Address - Phone:360-774-1534
Mailing Address - Fax:
Practice Address - Street 1:637 H ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-5243
Practice Address - Country:US
Practice Address - Phone:360-774-1534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8336166Medicaid
AB20565Medicare PIN
WAP08664Medicare UPIN