Provider Demographics
NPI:1720169329
Name:REUNION PHYSICAL THERAPY PS
Entity Type:Organization
Organization Name:REUNION PHYSICAL THERAPY PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NIEL
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:253-756-8668
Mailing Address - Street 1:1802 S UNION AVENUE
Mailing Address - Street 2:#100
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1947
Mailing Address - Country:US
Mailing Address - Phone:253-756-8668
Mailing Address - Fax:253-759-5138
Practice Address - Street 1:1802 S UNION AVENUE
Practice Address - Street 2:#100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1947
Practice Address - Country:US
Practice Address - Phone:253-756-8668
Practice Address - Fax:253-759-5138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7071921Medicaid
WA8805549Medicare ID - Type Unspecified