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Organization
ELITE REHABILITATION MEDICINE PLLC
Active
Organization
ELITE REHABILITATION MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE NICACIO MD (OWNER)
(360) 910-3414
Entity
Organization
Contact information
Practice address
905 SE 345TH AVE, WASHOUGAL, WA 98671-9542
(360) 910-3414
Mailing address
905 SE 345TH AVE, WASHOUGAL, WA 98671-9542
(360) 910-3414
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
05/22/2023
Last updated
05/22/2023
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