Provider Demographics
NPI:1295066140
Name:NEW ATHLETE INC
Entity type:Organization
Organization Name:NEW ATHLETE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:ARP THERAPIST
Authorized Official - Phone:360-567-0553
Mailing Address - Street 1:7219 NE HIGHWAY 99
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665
Mailing Address - Country:US
Mailing Address - Phone:360-567-0553
Mailing Address - Fax:360-258-1531
Practice Address - Street 1:7219 NE HIGHWAY 99
Practice Address - Street 2:SUITE 101
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8878
Practice Address - Country:US
Practice Address - Phone:360-567-0553
Practice Address - Fax:360-258-1531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Single Specialty