1790743003 NPI number — MVP PHYSICAL THERAPY, INC.

Table of content: (NPI 1790743003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790743003 NPI number — MVP PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MVP 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:
MVP PHYSICAL THERAPY
Provider Other Organization Name Type Code:
5
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:
1790743003
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4040 ORCHARD ST. W.
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FIRCREST
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-564-1560
Provider Business Mailing Address Fax Number:
253-564-4449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14207 MERIDIAN E STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-770-1807
Provider Business Practice Location Address Fax Number:
951-973-7216
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
MARGARITA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CREDENTIALING AND PROVIDER SERVICES
Authorized Official Telephone Number:
951-696-9353

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225700000X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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