1255871299 NPI number — POWER UP THERAPY, LLC

Table of content: (NPI 1255871299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255871299 NPI number — POWER UP THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POWER UP THERAPY, LLC
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:
1255871299
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 NW HOLLY ST
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
ISSAQUAH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98027-2815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-830-1778
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 NW HOLLY ST
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
ISSAQUAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98027-2815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-830-1778
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2017

Additional Information

Authorized Official

Authorized Official Last Name:
DALRYMPLE
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER AND PRESIDENT
Authorized Official Telephone Number:
425-830-1778

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1073990735 . This is a "NPI INDIVIDUAL" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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