Provider Demographics
NPI:1740584762
Name:PIONEER PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:PIONEER PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOYD
Authorized Official - Middle Name:K
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-854-9924
Mailing Address - Street 1:108 N TOWNSHIP ST STE F
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-1232
Mailing Address - Country:US
Mailing Address - Phone:360-854-9924
Mailing Address - Fax:360-854-9743
Practice Address - Street 1:108 N TOWNSHIP ST STE F
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1232
Practice Address - Country:US
Practice Address - Phone:360-854-9924
Practice Address - Fax:360-854-9743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty