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Organization
PHASE 1 PHYSICAL THERAPY PS
Active
Organization
PHASE 1 PHYSICAL THERAPY PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOEL T SAN NICOLAS PT (ADMINISTRATOR)
(509) 465-5663
Entity
Organization
Contact information
Practice address
5928 HIGHWAY 291, NINE MILE FALLS, WA 99026-9525
(509) 465-5663
(509) 467-8663
Mailing address
PO BOX 549, NINE MILE FALLS, WA 99026-0549
(509) 465-5663
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7116437
—
WA
Enumeration date
05/11/2006
Last updated
08/22/2020
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