Provider Demographics
NPI:1730242884
Name:TOTAL HEALTH CORPORATION
Entity type:Organization
Organization Name:TOTAL HEALTH CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:FULLING
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PT
Authorized Official - Phone:360-432-2193
Mailing Address - Street 1:2142 W RAILROAD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-7813
Mailing Address - Country:US
Mailing Address - Phone:360-426-0175
Mailing Address - Fax:360-432-2193
Practice Address - Street 1:2142 W RAILROAD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-7813
Practice Address - Country:US
Practice Address - Phone:360-426-0175
Practice Address - Fax:360-432-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000078162251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA125536OtherLABOR AND INDUSTRIES
WA8347130Medicaid
WA7095037Medicaid
WA8347130Medicaid
WAGAB11126Medicare ID - Type UnspecifiedMEDICARE GROUP