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Organization
PEACEHEALTH
Active
Organization
PEACEHEALTH
Active
Other names
St. John Medical Center - Outpatient Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS HAYWOOD (REGIONAL VP/CFO)
(360) 414-5797
Entity
Organization
Contact information
Practice address
852 COMMERCE AVE, LONGVIEW, WA 98632-2406
(360) 501-3750
(360) 501-3755
Mailing address
PO BOX 3002, LONGVIEW, WA 98632-0302
(360) 501-3750
(360) 501-3755
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
Primary
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
—
Other
Enumeration date
03/10/2006
Last updated
07/29/2011
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