1578508909 NPI number — WASHINGTON THERAPY GROUP, INC

Table of content: (NPI 1578508909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578508909 NPI number — WASHINGTON THERAPY GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON THERAPY GROUP, INC
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:
WASHINGTON HAND THERAPY
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:
1578508909
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12910 TOTEM LAKE BLVD NE STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIRKLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98034-2955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-924-2631
Provider Business Mailing Address Fax Number:
888-924-2630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17924 140TH AVE NE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
WOODINVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98072-4315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-924-2631
Provider Business Practice Location Address Fax Number:
888-924-2630
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SENANAYAKE
Authorized Official First Name:
ROZANNI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
888-924-2631

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  OT00002250 , 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)





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