1598725798 NPI number — ADVANCE PHYSICAL THERAPY 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 1598725798 NPI number — ADVANCE PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCE 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:
1598725798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15623 1ST AVE S
Provider Second Line Business Mailing Address:
STE C
Provider Business Mailing Address City Name:
BURIEN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98148-1292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-444-6320
Provider Business Mailing Address Fax Number:
206-444-6302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15623 1ST AVE S
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98148-1292
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-444-6320
Provider Business Practice Location Address Fax Number:
206-444-6302
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BENTLEY
Authorized Official First Name:
BRADFORD
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
206-444-6320

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT00007787 , 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: 0142606 . This is a "DEPT OF L & I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8940084 . This is a "CRIME VICTIMS ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7104300 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G8865497 . This is a "MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5411BE . This is a "REGENCE ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: GAB18641 . This is a "MEDICARE (OLD IND NUMBER)" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 353866900 . This is a "FEDERAL LABOR ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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