| NPI | 1942966544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAREN BOWLBY Authorized Official 360-575-8897 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2021-11-09 |
| Last Update Date | 2022-02-17 |