| NPI | 1134276306 |
|---|---|
| Doing Business As | MEDICAL LAKE PHYSICAL THERAPY |
| Entity Type | Organization |
| Authorized Contact | NOLA B PETRUCELLY Owner 509-326-8878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00008595) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00008073) |
| 225100000X Physical Therapist (Licence: WA PT00007579) | |
| 225100000X Physical Therapist (Licence: WA PT00002678) | |
| 225100000X Physical Therapist (Licence: WA PT00008218) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2007-12-27 |