Provider Demographics
NPI:1922515485
Name:VIOLET EBERLY, PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:VIOLET EBERLY, PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIOLET
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:EBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:509-207-9060
Mailing Address - Street 1:37 LAMBERT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:WA
Mailing Address - Zip Code:99166-9558
Mailing Address - Country:US
Mailing Address - Phone:509-207-9060
Mailing Address - Fax:
Practice Address - Street 1:56 N CLARK AVE
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:WA
Practice Address - Zip Code:99166-5024
Practice Address - Country:US
Practice Address - Phone:509-207-9060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010071261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy