Provider Demographics
NPI:1306058979
Name:BIOMECHANICAL SPORTS THERAPY, INC
Entity type:Organization
Organization Name:BIOMECHANICAL SPORTS THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-665-3156
Mailing Address - Street 1:18 N WORTHEN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-6137
Mailing Address - Country:US
Mailing Address - Phone:509-665-3156
Mailing Address - Fax:509-665-0414
Practice Address - Street 1:18 N WORTHEN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6137
Practice Address - Country:US
Practice Address - Phone:509-665-3156
Practice Address - Fax:509-665-0414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0122973OtherLABOR & INDUSTRIES
WA7097785Medicaid
WA0122973OtherLABOR & INDUSTRIES