Provider Demographics
NPI:1639185309
Name:ANUNCIADO, DWIGHT (MSPT)
Entity Type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:
Last Name:ANUNCIADO
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E RESERVE ST STE 104
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3875
Mailing Address - Country:US
Mailing Address - Phone:360-573-2266
Mailing Address - Fax:360-573-1502
Practice Address - Street 1:223 E RESERVE ST STE 104
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3875
Practice Address - Country:US
Practice Address - Phone:360-713-2500
Practice Address - Fax:360-573-1502
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2023-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134348Medicare ID - Type UnspecifiedMEDICARE ID NUMBER