| NPI | 1952500209 |
|---|---|
| Other Name | PROVIDENCE CENTRALIA HOSPITAL - PHYSIATRY |
| Entity Type | Organization |
| Authorized Contact | NICOLE QUINN Payor Credentialing Manager 425-525-6715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Additional Taxonomies | 261QX0100X Clinic/Center, Occupational Medicine |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2010-12-22 |