Organization
EAGLE ROCK PHYSICAL THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA DIANE SONNEMAN PT (CO OWNER AUTHORIZED OFFICIAL)
(509) 689-4301
Entity
Organization
Contact information
Practice address
411 HOSPITAL WAY, BREWSTER, WA 98812
(509) 689-4301
(509) 689-4307
Mailing address
PO BOX 769, 411 HOSPITAL WAY, BREWSTER, WA 98812
(509) 689-4301
(509) 689-4307
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00003294
WA
225100000X
Physical Therapist
PT00006129
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0206563
L & I BRIAN
WV
01
—
0206566
L & I USR
WA
05
—
8323479
—
WA
01
—
8374126
UNITED MEDICAL
—
05
—
8374126
—
WA
Enumeration date
10/23/2006
Last updated
08/22/2020
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