Provider Demographics
NPI:1184683948
Name:WHATCOM PHYSICAL THERAPY INC PS
Entity type:Organization
Organization Name:WHATCOM PHYSICAL THERAPY INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:616-356-5000
Mailing Address - Street 1:250 G ST
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-4019
Mailing Address - Country:US
Mailing Address - Phone:360-332-8167
Mailing Address - Fax:360-332-0931
Practice Address - Street 1:250 G ST
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-4019
Practice Address - Country:US
Practice Address - Phone:360-332-8167
Practice Address - Fax:360-332-0931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2025-06-02
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
WAGAB19949Medicare PIN