Basic Information
| Provider Information | |||||||||
| NPI: | 1942491378 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAJERA | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | LAGRIMAS | ||||||||
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| OtherLastName: | NAJERA | ||||||||
| OtherFirstName: | PHILIP | ||||||||
| OtherMiddleName: | LAGRIMAS | ||||||||
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| OtherCredential: | MPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4409 NW ANDERSON HILL RD | ||||||||
| Address2: | |||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983836807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606986630 | ||||||||
| FaxNumber: | 3606987002 | ||||||||
| Practice Location | |||||||||
| Address1: | 4409 NW ANDERSON HILL RD | ||||||||
| Address2: | |||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983836807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606986630 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2007 | ||||||||
| LastUpdateDate: | 12/13/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00007917 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 8497489 | 05 | WA | MEDICAID | 0224388 | 01 | WA | LABOR AND INDUSTRIES | OTHER |