Provider Demographics
NPI:1952666315
Name:CENTRALIA PHYSICAL THERAPY INC PS
Entity Type:Organization
Organization Name:CENTRALIA PHYSICAL THERAPY INC PS
Other - Org Name:CHEHALIS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BUONO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-996-4410
Mailing Address - Street 1:1118 VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-1870
Mailing Address - Country:US
Mailing Address - Phone:360-736-5273
Mailing Address - Fax:360-736-5053
Practice Address - Street 1:1118 VIEW AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-1870
Practice Address - Country:US
Practice Address - Phone:360-736-5273
Practice Address - Fax:360-736-5053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 7854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty