COLUMBIA PHYSICAL THERAPY INC PS

Provider Demographics

• NPI: 1457397531
• Name: COLUMBIA PHYSICAL THERAPY INC PS
• Entity Type: Organization
• Organization Name: COLUMBIA PHYSICAL THERAPY INC PS
• Authorized Official - Title/Position: BOARD OF DIRECTORS
• Authorized Official - First Name: CLARK
• Authorized Official - Last Name: HEATH
• Authorized Official - Credentials: PT
• Authorized Official - Phone: 509-544-0265
• Mailing Address - Street 1: 7201 W CLEARWATER AVE STE B101
• Mailing Address - City: KENNEWICK
• Mailing Address - State: WA
• Mailing Address - Zip Code: 99336-1694
• Mailing Address - Country: US
• Mailing Address - Phone: 509-544-0265
• Mailing Address - Fax: 509-987-1614
• Practice Address - Street 1: 7201 W CLEARWATER AVE STE B101
• Practice Address - City: KENNEWICK
• Practice Address - State: WA
• Practice Address - Zip Code: 99336-1694
• Practice Address - Country: US
• Practice Address - Phone: 509-544-0265
• Practice Address - Fax: 509-987-1614
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-06-20
• Last Update Date: 2013-12-19

Provider Licenses

State	License ID	Taxonomies
WA	PT00007870	225100000X
WA	PT00009869	225100000X
WA	PT00008684	225100000X
WA	PT00006293	225100000X
WA	PT00006195	225100000X
WA	PT00007653	225100000X
OR	4284	225100000X
OR	4566	225100000X
WA	PT00009468	225100000X
WA	PT00006264	225100000X
WA	PT00006198	225100000X
WA	PT00008040	225100000X
WA	PT00009184	225100000X
OR	4916	225100000X
WA	PT00007804	225100000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist		Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
WA	7047525	Medicaid
WA	7091325	Medicaid
WA	7089956	Medicaid
OR	R111697	Medicare PIN
ID	1379482	Medicare PIN
WA	GAB12108	Medicare PIN
WA	7091325	Medicaid
OR	R115372	Medicare PIN