Provider Demographics
NPI:1639165681
Name:PREPULA, IRENE (PT)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:PREPULA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 893
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-0893
Mailing Address - Country:US
Mailing Address - Phone:360-687-5666
Mailing Address - Fax:360-666-8346
Practice Address - Street 1:18503 NE 219TH ST
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9282
Practice Address - Country:US
Practice Address - Phone:360-687-5666
Practice Address - Fax:360-666-8346
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00000946225100000X
OR0520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7297609Medicaid
S88738Medicare UPIN
WA7297609Medicaid