Provider Demographics
NPI:1700279205
Name:HEALING CRANIOSACRAL & PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:HEALING CRANIOSACRAL & PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-702-6494
Mailing Address - Street 1:13512 NE 238TH WAY
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4792
Mailing Address - Country:US
Mailing Address - Phone:360-702-6494
Mailing Address - Fax:
Practice Address - Street 1:318 E MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-8508
Practice Address - Country:US
Practice Address - Phone:360-702-6494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 00009154261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy