Provider Demographics
NPI:1811146582
Name:MCCAULEY, PETRA S (PT)
Entity type:Individual
Prefix:
First Name:PETRA
Middle Name:S
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 GRANT RD
Mailing Address - Street 2:SUITE B27
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-5383
Mailing Address - Country:US
Mailing Address - Phone:509-884-1437
Mailing Address - Fax:509-884-2811
Practice Address - Street 1:230 GRANT RD
Practice Address - Street 2:SUITE B27
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-5383
Practice Address - Country:US
Practice Address - Phone:509-884-1437
Practice Address - Fax:509-884-2811
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60045097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1811146582Medicaid