Provider Demographics
NPI:1619549417
Name:ABLAN PT LLC
Entity Type:Organization
Organization Name:ABLAN PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ABLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:360-270-4199
Mailing Address - Street 1:2737 HARRIS STREET RD
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-5312
Mailing Address - Country:US
Mailing Address - Phone:360-270-4199
Mailing Address - Fax:
Practice Address - Street 1:351 THREE RIVERS DR STE 1137
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-3129
Practice Address - Country:US
Practice Address - Phone:360-270-4199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty