Provider Demographics
NPI:1255773362
Name:SALISH SEA PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:SALISH SEA PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-221-5432
Mailing Address - Street 1:6441 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236-9600
Mailing Address - Country:US
Mailing Address - Phone:360-221-5432
Mailing Address - Fax:360-221-5434
Practice Address - Street 1:6441 HARDING AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236-9600
Practice Address - Country:US
Practice Address - Phone:360-221-5432
Practice Address - Fax:360-221-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy