Provider Demographics
NPI:1649248154
Name:WINTHROP PHYSICAL THERAPY PS
Entity type:Organization
Organization Name:WINTHROP PHYSICAL THERAPY PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:B
Authorized Official - Last Name:DICKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, SCS
Authorized Official - Phone:509-996-8234
Mailing Address - Street 1:PO BOX 814
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:WA
Mailing Address - Zip Code:98862-0814
Mailing Address - Country:US
Mailing Address - Phone:509-996-8234
Mailing Address - Fax:509-996-2193
Practice Address - Street 1:202 WHITE AVE
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:WA
Practice Address - Zip Code:98862-9774
Practice Address - Country:US
Practice Address - Phone:509-996-8234
Practice Address - Fax:509-996-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
WA6021189172251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7120769Medicaid
WA602118917OtherUNIFIED BUSINESS IDENTIFI
WA0200051OtherLABOR & INDUSTRIES
WA193601200OtherUS DEPT OF LABOR OWCP
WAGAB27140Medicare ID - Type UnspecifiedNORIDIAN
WA193601200OtherUS DEPT OF LABOR OWCP