1306903877 NPI number — NORTHWEST PEDIATRIC THERAPIES, PS

Table of content: (NPI 1306903877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306903877 NPI number — NORTHWEST PEDIATRIC THERAPIES, PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST PEDIATRIC THERAPIES, PS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRISCILLA A COYNER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306903877
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
710 NW JUNIPER ST
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
ISSAQUAH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98027-2717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-392-7989
Provider Business Mailing Address Fax Number:
425-391-2554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 NW JUNIPER ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
ISSAQUAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98027-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-392-7989
Provider Business Practice Location Address Fax Number:
425-391-2554
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COYNER
Authorized Official First Name:
PRISCILLA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
425-392-7989

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT00002750 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7038037 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CO2118 . This is a "REGENCE PROVIDER NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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