Provider Demographics
NPI:1215120456
Name:SAMMAMISH PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:SAMMAMISH PHYSICAL THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HOPE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:425-898-8540
Mailing Address - Street 1:22840 NE 8TH STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-7263
Mailing Address - Country:US
Mailing Address - Phone:425-898-8540
Mailing Address - Fax:425-898-1570
Practice Address - Street 1:22840 NE 8TH STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7263
Practice Address - Country:US
Practice Address - Phone:425-898-8540
Practice Address - Fax:425-898-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00001084225100000X
WA602354125261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8809331Medicare UPIN