Provider Demographics
NPI:1609279017
Name:NORTHWEST RETURN TO WORK MT VERNON
Entity Type:Organization
Organization Name:NORTHWEST RETURN TO WORK MT VERNON
Other - Org Name:VALLEY REHAB PT AND RTW CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:STANG
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PT
Authorized Official - Phone:360-424-5215
Mailing Address - Street 1:1600 ROOSEVELT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2646
Mailing Address - Country:US
Mailing Address - Phone:360-424-5215
Mailing Address - Fax:360-424-4074
Practice Address - Street 1:1600 ROOSEVELT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2646
Practice Address - Country:US
Practice Address - Phone:360-424-5215
Practice Address - Fax:360-424-4074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000062012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty