Provider Demographics
NPI:1992192231
Name:STARGAIT PHYSICAL THERAPY
Entity Type:Organization
Organization Name:STARGAIT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WENTZEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-356-6811
Mailing Address - Street 1:16420 SE MCGILLIVRAY BLVD STE 103-355
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-3461
Mailing Address - Country:US
Mailing Address - Phone:541-292-4244
Mailing Address - Fax:855-840-8203
Practice Address - Street 1:6305 NE 47TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661
Practice Address - Country:US
Practice Address - Phone:360-356-6811
Practice Address - Fax:855-840-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60013093261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1992192231Medicaid