1598725798 NPI number — ADVANCE PHYSICAL THERAPY INC

Table of content: (NPI 1598725798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598725798 NPI number — ADVANCE PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCE PHYSICAL THERAPY 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:
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:
1598725798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15623 1ST AVE S
Provider Second Line Business Mailing Address:
STE C
Provider Business Mailing Address City Name:
BURIEN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98148-1292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-444-6320
Provider Business Mailing Address Fax Number:
206-444-6302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15623 1ST AVE S
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98148-1292
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-444-6320
Provider Business Practice Location Address Fax Number:
206-444-6302
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BENTLEY
Authorized Official First Name:
BRADFORD
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
206-444-6320

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT00007787 , 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: 0142606 . This is a "DEPT OF L & I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8940084 . This is a "CRIME VICTIMS ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7104300 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G8865497 . This is a "MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5411BE . This is a "REGENCE ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: GAB18641 . This is a "MEDICARE (OLD IND NUMBER)" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 353866900 . This is a "FEDERAL LABOR ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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