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Organization
TWIN RIVERS PHYSICAL THERAPY, LLC
Active
Organization
TWIN RIVERS PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRENT W WAHLBERG JR. RPT (PT OWNER)
(509) 758-8510
Entity
Organization
Contact information
Practice address
725 6TH ST, STE 101, CLARKSTON, WA 99403-2006
(509) 758-8510
(509) 751-9149
Mailing address
725 6TH ST, STE 101, CLARKSTON, WA 99403-2006
(509) 758-8510
(509) 751-9149
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00005041
WA
225100000X
Physical Therapist
PT396
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010007644
BLUE SHIELD
—
01
—
131422
LI
WA
05
—
7018757
—
WA
Enumeration date
11/27/2006
Last updated
12/17/2009
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