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Organization

PRISM PEDIATRIC THERAPY ASSOCIATES PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JENNIFER RAINEY-YATES PT, DPT (OWNER)
(360) 597-4048
Entity
Organization

Contact information

Practice address
7409 NE HAZEL DELL AVE, VANCOUVER, WA 98665-8310
(208) 287-9420
Mailing address
1940 S BONITO WAY STE 190, MERIDIAN, ID 83642-5618
(208) 287-9420

Taxonomy

Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT-60135582
WA
225XP0200X
Pediatric Occupational Therapist
OT-00003758
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
603502448
UBI NUMBER
WA
Enumeration date
01/28/2016
Last updated
03/01/2023
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