Provider Demographics
NPI:1215461199
Name:BRIDLE TRAILS PHYSICAL THERAPY AND ATHLETIC TRAINING LLC
Entity type:Organization
Organization Name:BRIDLE TRAILS PHYSICAL THERAPY AND ATHLETIC TRAINING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-307-0032
Mailing Address - Street 1:6513 132ND AVE NE # 375
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-8628
Mailing Address - Country:US
Mailing Address - Phone:425-889-0776
Mailing Address - Fax:425-889-0857
Practice Address - Street 1:13120 NE 70TH PL STE 203
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-8570
Practice Address - Country:US
Practice Address - Phone:425-889-0776
Practice Address - Fax:425-889-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60169095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty