1477582641 NPI number — PACIFIC BALANCE AND REHABILITATION CLINIC PLLC

Table of content: (NPI 1477582641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477582641 NPI number — PACIFIC BALANCE AND REHABILITATION CLINIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC BALANCE AND REHABILITATION CLINIC PLLC
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:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477582641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9940
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98109-0940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-448-1906
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 MERCER ST
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-4650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-448-1906
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORROW
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
THERON
Authorized Official Title or Position:
PRINCIPAL
Authorized Official Telephone Number:
206-448-1906

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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