Provider Demographics
NPI:1831289032
Name:KARNOFSKI, JARROD PAUL (DPT ATC CSCS)
Entity Type:Individual
Prefix:MR
First Name:JARROD
Middle Name:PAUL
Last Name:KARNOFSKI
Suffix:
Gender:M
Credentials:DPT ATC CSCS
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 105
Mailing Address - Street 2:
Mailing Address - City:ILWACO
Mailing Address - State:WA
Mailing Address - Zip Code:98624
Mailing Address - Country:US
Mailing Address - Phone:360-642-8305
Mailing Address - Fax:360-642-3408
Practice Address - Street 1:316 1ST AVE NORTH
Practice Address - Street 2:OCEAN BEACH PHYSICAL THERAPY
Practice Address - City:ILWACO
Practice Address - State:WA
Practice Address - Zip Code:98624
Practice Address - Country:US
Practice Address - Phone:360-642-8551
Practice Address - Fax:360-642-3408
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009830225100000X
OR5257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8433179Medicaid
WA8433179Medicaid