Provider Demographics
NPI:1619245396
Name:BAY STREET OASIS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:BAY STREET OASIS PHYSICAL THERAPY LLC
Other - Org Name:OASIS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-676-8077
Mailing Address - Street 1:301 W HOLLY ST
Mailing Address - Street 2:SUITE M6
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4361
Mailing Address - Country:US
Mailing Address - Phone:360-676-8077
Mailing Address - Fax:360-715-8574
Practice Address - Street 1:301 W HOLLY ST
Practice Address - Street 2:SUITE M6
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4361
Practice Address - Country:US
Practice Address - Phone:360-676-8077
Practice Address - Fax:360-715-8574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7078793Medicaid
WA105059OtherL&I OF WA
WAS28844Medicare UPIN