Provider Demographics
NPI:1982320941
Name:POLARIS THERAPY LLC
Entity Type:Organization
Organization Name:POLARIS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:JINDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-885-7374
Mailing Address - Street 1:5219 W CLEARWATER AVE STE 17
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1980
Mailing Address - Country:US
Mailing Address - Phone:509-885-7374
Mailing Address - Fax:
Practice Address - Street 1:402 E YAKIMA AVE STE 447E
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-5407
Practice Address - Country:US
Practice Address - Phone:509-885-7374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)