Provider Demographics
NPI:1336343789
Name:FORWARD MOTION PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:FORWARD MOTION PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CORY
Authorized Official - Last Name:BLICKENSTAFF
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-600-2272
Mailing Address - Street 1:13023 NE HIGHWAY 99
Mailing Address - Street 2:SUITE 7 PMB 109
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2767
Mailing Address - Country:US
Mailing Address - Phone:360-600-2272
Mailing Address - Fax:877-362-9612
Practice Address - Street 1:1701 E EVERGREEN BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-4232
Practice Address - Country:US
Practice Address - Phone:360-600-2272
Practice Address - Fax:877-362-9612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000093302251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8865674Medicare PIN