Organization
BONNEY LAKE PHYSICAL THERAPY AND HAND REHAB, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL ANDREW EGBERT PT (PRESIDENT)
(253) 862-2575
Entity
Organization
Contact information
Practice address
20910 STATE ROUTE 410 E, BONNEY LAKE, WA 98391-6302
(253) 862-2575
(253) 862-2675
Mailing address
20910 STATE ROUTE 410 E, BONNEY LAKE, WA 98391-6302
(253) 862-2575
(253) 862-2675
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5418
WA
2251X0800X
Orthopedic Physical Therapist
PT5418
WA
225XH1200X
Hand Occupational Therapist
OT2499
WA
225XP0019X
Physical Rehabilitation Occupational Therapist
OT2499
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
246111
LABOR AND INDUSTRIES OT/ BRANDY
WA
01
—
246114
LABOR AND INDUSTRIES PT/ MICHAEL
WA
01
—
264113
LABOR AND INDUSTRIES
WA
01
—
6598CA
BLUE SHILD BRANDY OT
WA
05
—
7146897
—
WA
01
—
7421EG
BLUE SHIELD MICHAEL PT
WA
01
—
8368854
MEDICAID OCCUPATIONAL THERAPY
WA
01
—
8543712
MEDICAID PHYSICAL THERAPY
WA
01
—
G8879641
MEDICARE PTAN BRANDY
WA
01
—
G8879917
INDIVIDUAL PTAN MICHCAEL
WA
Enumeration date
01/26/2009
Last updated
01/19/2015
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