Provider Demographics
NPI:1699835645
Name:PHYSICAL THERAPY SPECIALISTS, PS
Entity type:Organization
Organization Name:PHYSICAL THERAPY SPECIALISTS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:BONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:360-423-1113
Mailing Address - Street 1:PHYSICAL THERAPY SPECIALISTS
Mailing Address - Street 2:PO BOX 2369
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:360-423-1113
Mailing Address - Fax:360-423-1115
Practice Address - Street 1:PHYSICAL THERAPY SPECIALISTS
Practice Address - Street 2:1152 DOUGLAS ST
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632
Practice Address - Country:US
Practice Address - Phone:360-423-1113
Practice Address - Fax:360-423-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7107972Medicaid
WA0130397OtherL&I
WAGAB23014Medicare ID - Type Unspecified