1467632745 NPI number — OLYMPIA PHYSICAL THERAPY & INDUSTRIAL REHABILITATION, INC.

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 1467632745 NPI number — OLYMPIA PHYSICAL THERAPY & INDUSTRIAL REHABILITATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLYMPIA PHYSICAL THERAPY & INDUSTRIAL REHABILITATION, 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:
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:
1467632745
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2755 MOTTMAN RD SW
Provider Second Line Business Mailing Address:
OLYMPIA PHYSICAL THERAPY & REHABILITATION, INC.
Provider Business Mailing Address City Name:
TUMWATER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98512-5684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-352-5077
Provider Business Mailing Address Fax Number:
360-352-5022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8750 TALON LN NE
Provider Second Line Business Practice Location Address:
HAWKS PRAIRIE SUITE C
Provider Business Practice Location Address City Name:
LACEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98516-6642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-456-1072
Provider Business Practice Location Address Fax Number:
360-459-9954
Provider Enumeration Date:
11/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROBBINS
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
MPT / OWNER
Authorized Official Telephone Number:
360-352-5077

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: CK7840 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 017966 0001 . This is a "PACIFICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7115074 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0166743 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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