| NPI | 1912318130 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Doing Business As | PROVIDENCE PHYSIATRY |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secretary Enrollments 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2024-09-30 |