Provider Demographics
NPI:1104568179
Name:PACIFIC PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:PACIFIC PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-329-7052
Mailing Address - Street 1:1950 POTTERY AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2501
Mailing Address - Country:US
Mailing Address - Phone:360-329-7052
Mailing Address - Fax:360-329-7053
Practice Address - Street 1:3114 NW RANDALL WAY STE 300
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7676
Practice Address - Country:US
Practice Address - Phone:360-625-9161
Practice Address - Fax:360-625-9215
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACIFIC PHYSICAL THERAPY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2041063Medicaid