1194943381 NPI number — ADULT REHABILITATION THERAPIES, PLLC

Table of content: (NPI 1194943381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194943381 NPI number — ADULT REHABILITATION THERAPIES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADULT REHABILITATION THERAPIES, PLLC
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:
1194943381
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6225
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FEDERAL WAY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-839-3403
Provider Business Mailing Address Fax Number:
253-839-3412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31200 23RD AVE SOUTH
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-839-3403
Provider Business Practice Location Address Fax Number:
253-839-3412
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FULLER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
253-839-3403

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  602023026 , 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: 7101710 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G8870660 . This is a "MEDICARE PTAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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