Provider Demographics
NPI:1285311944
Name:PHYSIOMENDER LLC
Entity type:Organization
Organization Name:PHYSIOMENDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:MR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:206-755-2236
Mailing Address - Street 1:1704 NORMAN ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-1034
Mailing Address - Country:US
Mailing Address - Phone:206-755-2236
Mailing Address - Fax:
Practice Address - Street 1:1108 SPRINGWATER AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1548
Practice Address - Country:US
Practice Address - Phone:206-755-2236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty