1598889503 NPI number — SYMMETRY PHYSICAL THERAPY PLLC

Table of content: (NPI 1598889503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598889503 NPI number — SYMMETRY PHYSICAL THERAPY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYMMETRY 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:
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:
1598889503
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1940 116TH AVE NE
Provider Second Line Business Mailing Address:
100
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98004-3011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-451-0649
Provider Business Mailing Address Fax Number:
425-451-0655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1940 116TH AVE NE
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-3011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-451-0649
Provider Business Practice Location Address Fax Number:
425-451-0655
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PAINE
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
GORDON
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
425-451-0649

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: 5781SY . This is a "BLUE CROSS- BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0194962 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7105026 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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