1952394546 NPI number — MARYSVILLE PHYSICAL THERAPY, INC.

Table of content: (NPI 1952394546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952394546 NPI number — MARYSVILLE PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARYSVILLE 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:
NORTHSOUND PHYSICAL 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:
1952394546
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27500 102ND AVE NW
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
STANWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98292-8092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-629-7528
Provider Business Mailing Address Fax Number:
360-629-7632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9516 STATE AVE
Provider Second Line Business Practice Location Address:
STE. B
Provider Business Practice Location Address City Name:
MARYSVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98270-2277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-658-8857
Provider Business Practice Location Address Fax Number:
360-659-8296
Provider Enumeration Date:
08/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HEDEEN
Authorized Official First Name:
KARL
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
360-629-7528

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 118546 . This is a "DEPT OF L&I GROUP #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: NO5342 . This is a "REGENCE BLUE SHIELD GRP#" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8933936 . This is a "DEPT OF L&I CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7091077 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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