| NPI | 1205021276 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN J RUSSON Owner 360-794-7520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: WA PT0000754) |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2009-02-18 |