Provider Demographics
NPI:1194943381
Name:ADULT REHABILITATION THERAPIES, PLLC
Entity type:Organization
Organization Name:ADULT REHABILITATION THERAPIES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:253-839-3403
Mailing Address - Street 1:PO BOX 6225
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98063
Mailing Address - Country:US
Mailing Address - Phone:253-839-3403
Mailing Address - Fax:253-839-3412
Practice Address - Street 1:31200 23RD AVE SOUTH
Practice Address - Street 2:SUITE 100
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:253-839-3403
Practice Address - Fax:253-839-3412
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADULT REHABILITATION THERAPIES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-23
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602023026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7101710Medicaid
WAG8870660OtherMEDICARE PTAN