1760682116 NPI number — HIGHLINE HAND THERAPY DBA SOUTHWEST HAND THERAPY

Table of content: (NPI 1760682116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760682116 NPI number — HIGHLINE HAND THERAPY DBA SOUTHWEST HAND THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGHLINE HAND THERAPY DBA SOUTHWEST HAND THERAPY
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:
1760682116
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 SW 160TH ST
Provider Second Line Business Mailing Address:
STE. 201
Provider Business Mailing Address City Name:
BURIEN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98166-3003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-244-4263
Provider Business Mailing Address Fax Number:
206-244-8703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4621 35TH AVE SW
Provider Second Line Business Practice Location Address:
STE. A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98126-2767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-935-1215
Provider Business Practice Location Address Fax Number:
206-935-0207
Provider Enumeration Date:
07/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WOLF
Authorized Official First Name:
LYNNE
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
206-244-4263

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , 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: 7136948 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HI0027 . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7683881 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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