Provider Demographics
NPI:1356554885
Name:ANUNCIADO ENTERPRISES PC
Entity type:Organization
Organization Name:ANUNCIADO ENTERPRISES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:ANUNCIADO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:360-573-2266
Mailing Address - Street 1:1308 NE 134TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2725
Mailing Address - Country:US
Mailing Address - Phone:360-573-2266
Mailing Address - Fax:360-573-1502
Practice Address - Street 1:1308 NE 134TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2725
Practice Address - Country:US
Practice Address - Phone:360-573-2266
Practice Address - Fax:360-573-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty