Provider Demographics
NPI:1215445549
Name:INTECORE WA, INC
Entity type:Organization
Organization Name:INTECORE WA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:VERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-474-3274
Mailing Address - Street 1:5050 NE STATE WAY 303 #103-221
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311
Mailing Address - Country:US
Mailing Address - Phone:360-474-3274
Mailing Address - Fax:360-824-6720
Practice Address - Street 1:1550 NE RIDDELL RD STE 170
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3060
Practice Address - Country:US
Practice Address - Phone:360-474-3274
Practice Address - Fax:360-824-6720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60822534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty