Provider Demographics
NPI:1427237619
Name:TIMBERLINE REHABILITATION SERVICE, PS
Entity type:Organization
Organization Name:TIMBERLINE REHABILITATION SERVICE, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ZANE
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:360-567-2002
Mailing Address - Street 1:916 NE 112TH AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5104
Mailing Address - Country:US
Mailing Address - Phone:360-567-2002
Mailing Address - Fax:360-567-2005
Practice Address - Street 1:916 NE 112TH AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5104
Practice Address - Country:US
Practice Address - Phone:360-567-2002
Practice Address - Fax:360-567-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1427237619OtherGROUP NPI #
WAG8868883Medicare PIN