Provider Demographics
NPI:1619292232
Name:BASCO, WILANI SANTOS (PT)
Entity Type:Individual
Prefix:MRS
First Name:WILANI
Middle Name:SANTOS
Last Name:BASCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:WILANI
Other - Middle Name:DE LA CRUZ
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:P.O. BOX 373
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841
Mailing Address - Country:US
Mailing Address - Phone:509-422-3180
Mailing Address - Fax:
Practice Address - Street 1:520 2ND AVE S
Practice Address - Street 2:
Practice Address - City:OKANOGAN
Practice Address - State:WA
Practice Address - Zip Code:98840-9665
Practice Address - Country:US
Practice Address - Phone:509-422-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60130854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist