Provider Demographics
NPI:1659346153
Name:CENTRAL PHYSICAL THERAPY AND FITNESS, P.S.C.
Entity Type:Organization
Organization Name:CENTRAL PHYSICAL THERAPY AND FITNESS, P.S.C.
Other - Org Name:SANCTUARY FOR PHYSICAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MGR AND SEC TREAS OF CORP
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHAACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-860-3746
Mailing Address - Street 1:1917 FIR ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-3515
Mailing Address - Country:US
Mailing Address - Phone:206-860-3746
Mailing Address - Fax:360-344-2248
Practice Address - Street 1:1917 FIR ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-3515
Practice Address - Country:US
Practice Address - Phone:206-860-3746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA183442OtherLABOR & INDUSTRIES GRP #
WA183442OtherLABOR & INDUSTRIES GRP #
WA8802096Medicare PIN