Provider Demographics
NPI:1801083829
Name:PRO PLUS PHYSICAL THERAPY
Entity type:Organization
Organization Name:PRO PLUS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CARBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-496-0087
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:WA
Mailing Address - Zip Code:98356-0145
Mailing Address - Country:US
Mailing Address - Phone:360-496-0087
Mailing Address - Fax:
Practice Address - Street 1:250-C WESTLAKE AVENUE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:WA
Practice Address - Zip Code:98356-0145
Practice Address - Country:US
Practice Address - Phone:360-496-0087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8800890Medicare PIN