Provider Demographics
NPI:1265521983
Name:MACKAY, JOSEPH EARL (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EARL
Last Name:MACKAY
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11481 SW HALL BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8403
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-443-1402
Practice Address - Street 1:1408 N LOUISIANA ST
Practice Address - Street 2:SUITE 104 A
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7167
Practice Address - Country:US
Practice Address - Phone:509-783-1962
Practice Address - Fax:509-783-1706
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010246225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8862105Medicare PIN