| Organization Name: | PACIFIC NORTHWEST PHYSICAL THERAPY |
| NPI Number: | 1134506454 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRADLEY KIME (OWNER) |
| Mailing Address: | 225 I St Crescent City |
| State: | CA US |
| Postal Code: | 955314305 |
| Phone Number: | 7074649511 |
| Fax Number: | 7074649513 |
| NPI Enumeration Date: | 05/06/2015 |
| NPI Last Update Date: | 05/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 23616 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |