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Organization
PROFORMANCE PHYSICAL THERAPY, LLC
Active
Organization
PROFORMANCE PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT TIMOTHY BASHAW PT (OWNER)
(509) 338-9204
Entity
Organization
Contact information
Practice address
840 SE BISHOP BLVD, SUITE 200, PULLMAN, WA 99163-5502
(509) 338-9204
Mailing address
840 SE BISHOP BLVD, SUITE 200, PULLMAN, WA 99163-5502
(509) 338-9204
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0195909
DEPT. OF LABOR & INDUSTRY
WA
05
—
7127467
—
WA
Enumeration date
07/11/2006
Last updated
08/22/2020
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