1447718556 NPI number — NORTH PENINSULA PHYSICAL THERAPY, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447718556 NPI number — NORTH PENINSULA PHYSICAL THERAPY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH PENINSULA PHYSICAL THERAPY, 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:
6
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:
1447718556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 TUMWATER BLVD SE STE 113
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUMWATER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98501-6422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-528-3300
Provider Business Mailing Address Fax Number:
360-528-8162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19980 10TH AVE NE STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POULSBO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98370-6322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-598-1538
Provider Business Practice Location Address Fax Number:
360-598-1541
Provider Enumeration Date:
03/07/2019

Additional Information

Authorized Official

Authorized Official Last Name:
EISEN
Authorized Official First Name:
MIEKA
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
360-528-3300

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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