Provider Demographics
NPI:1700110590
Name:HOOD CANAL THERAPY AND FITNESS
Entity Type:Organization
Organization Name:HOOD CANAL THERAPY AND FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PTMS
Authorized Official - Phone:360-490-4136
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:WA
Mailing Address - Zip Code:98592-0132
Mailing Address - Country:US
Mailing Address - Phone:360-490-4136
Mailing Address - Fax:360-285-1225
Practice Address - Street 1:252 MCREAVY
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:WA
Practice Address - Zip Code:98592-0132
Practice Address - Country:US
Practice Address - Phone:360-490-4136
Practice Address - Fax:360-285-1225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006808101YM0800X
WALW00006768104100000X
WAPT00007741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty