1578948923 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 1578948923 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:
6
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:
1578948923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3502 S 12TH ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98405-2279
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:
425 SW 41ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98057-4926
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:
07/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
FORD
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
NOEL
Authorized Official Title or Position:
PHYSICAL THERAPIST/OWNER
Authorized Official Telephone Number:
253-564-2220

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT00006703 , 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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