Provider Demographics
NPI:1942410907
Name:RUE - PRIMAVERA OCCUPATIONAL & PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:RUE - PRIMAVERA OCCUPATIONAL & PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDOLYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:RUE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-279-8323
Mailing Address - Street 1:785 SE BAYSHORE DR.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277
Mailing Address - Country:US
Mailing Address - Phone:360-279-8323
Mailing Address - Fax:360-279-8772
Practice Address - Street 1:785 SE BAYSHORE DR.
Practice Address - Street 2:SUITE 102
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277
Practice Address - Country:US
Practice Address - Phone:360-279-8323
Practice Address - Fax:360-279-8772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X, 225100000X
WAPT00006648225100000X
WAPT00002981225100000X
WAOT0000093225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty