Provider Demographics
NPI:1720175219
Name:WEST GARLAND PHYSICAL THERAPY
Entity Type:Organization
Organization Name:WEST GARLAND PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-352-2037
Mailing Address - Street 1:PO BOX 11009
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-1009
Mailing Address - Country:US
Mailing Address - Phone:360-352-2037
Mailing Address - Fax:360-352-0637
Practice Address - Street 1:1403 W GARLAND AVE STE B
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2619
Practice Address - Country:US
Practice Address - Phone:509-325-2992
Practice Address - Fax:509-326-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7230063Medicaid
WAHY3445OtherREGENCE RIDER
WA0059965OtherL&I