1174640759 NPI number — A.I.M. PHYSICAL THERAPY, INC.

Table of content: (NPI 1174640759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174640759 NPI number — A.I.M. PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A.I.M. 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:
1174640759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 ALDER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUMNER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98390-1321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-216-3600
Provider Business Mailing Address Fax Number:
253-862-2675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 ALDER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMNER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98390-1321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-216-3600
Provider Business Practice Location Address Fax Number:
253-862-2675
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EGBERT
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
253-216-3600

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT00005418 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X , with the licence number: PT5418 , 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: 171896 . This is a "STATE WORKERS COMP." identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: GAB38573 . This is a "PTAN MEDICARE GROUP" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: GAB38573 . This is a "PTAN MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: GAB38574 . This is a "MEDICARE PTAN INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00061737 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101837600 . This is a "US DEPT OF LABOR PROVIDER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1093897613 . This is a "NPI INDIVIDUAL" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7126303 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: EG4516 . This is a "BLUE SHIELD PROVIDER NO." identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1174640759 . This is a "GROUP NPI AIM" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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