Provider Demographics
NPI:1831793603
Name:MANUAL MEDICINE & REHABILITATION CENTER PC, OF WA
Entity type:Organization
Organization Name:MANUAL MEDICINE & REHABILITATION CENTER PC, OF WA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:ALDONA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-737-9665
Mailing Address - Street 1:18633 SE STARK ST BLDG A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-5468
Mailing Address - Country:US
Mailing Address - Phone:360-737-9665
Mailing Address - Fax:
Practice Address - Street 1:18633 SE STARK ST BLDG A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-5468
Practice Address - Country:US
Practice Address - Phone:360-737-9665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty