| |
397 Sussex Ave E, Tenino, WA 98589-9272 | |
(360) 264-6622 | |
(360) 264-6624 |
Full Name | |
---|---|
Type | Facility |
Speciality | Physical Therapist |
Location | 397 Sussex Ave E, Tenino, Washington |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1679752968 | NPI | - | NPPES |
121283 | Other | WA | L&I |
CO5972 | Other | BLUE CROSS | |
TE5934 | Other | WA | REGENCE BLUE SHIELD |
7091473 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | PT00002127 (Washington) | Primary |
Mailing Address | Practice Location Address |
---|---|
Po Box 255, Tenino, WA 98589-0255 Ph: (360) 264-6622 | 397 Sussex Ave E, Tenino, WA 98589-9272 Ph: (360) 264-6622 |
Daniel Ray Coleman, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 397 Sussex Ave E, Ste A, Tenino, WA 98589 Phone: 360-264-6622 Fax: 360-264-6624 |