1275080301 NPI number — ABC PHYSICAL THERAPY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275080301 NPI number — ABC PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABC PHYSICAL THERAPY
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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275080301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3309 56TH ST NW
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
GIG HARBOR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98335-8572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-564-2220
Provider Business Mailing Address Fax Number:
253-564-2221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3309 56TH ST NW
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
GIG HARBOR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98335-8572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-564-2220
Provider Business Practice Location Address Fax Number:
253-564-2221
Provider Enumeration Date:
09/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HAMBY
Authorized Official First Name:
MELANEY
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTS MANAGER
Authorized Official Telephone Number:
253-564-2220

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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