Provider Demographics
NPI:1316161029
Name:NORTHWEST REHABILITATION INSTITUTE
Entity type:Organization
Organization Name:NORTHWEST REHABILITATION INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TERRALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KADRMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:360-694-9099
Mailing Address - Street 1:4421 NE ST JOHNS RD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-2573
Mailing Address - Country:US
Mailing Address - Phone:360-694-9099
Mailing Address - Fax:360-695-6638
Practice Address - Street 1:4421 NE ST JOHNS RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-2573
Practice Address - Country:US
Practice Address - Phone:360-694-9099
Practice Address - Fax:360-695-6638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT7006261QP2000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB39793OtherMEDICARE GRP
WA7027873Medicaid
WA8333759Medicaid
WA7027873Medicaid