Provider Demographics
NPI:1689701252
Name:WESTGATE ORTHOPAEDIC PHYSICAL THERAPY AND EXERCISE
Entity Type:Organization
Organization Name:WESTGATE ORTHOPAEDIC PHYSICAL THERAPY AND EXERCISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ERWIN
Authorized Official - Last Name:CULLINANE
Authorized Official - Suffix:
Authorized Official - Credentials:PT OCS
Authorized Official - Phone:253-756-7878
Mailing Address - Street 1:2102 N PEARL #203
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2550
Mailing Address - Country:US
Mailing Address - Phone:253-756-7878
Mailing Address - Fax:253-756-9634
Practice Address - Street 1:2102 N PEARL #203
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2550
Practice Address - Country:US
Practice Address - Phone:253-756-7878
Practice Address - Fax:253-756-9634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601693379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB20626Medicare ID - Type Unspecified