Provider Demographics
NPI:1306535422
Name:WIRTH, HARRISON CHARLES (DPT)
Entity type:Individual
Prefix:
First Name:HARRISON
Middle Name:CHARLES
Last Name:WIRTH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 NE 68TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7044
Mailing Address - Country:US
Mailing Address - Phone:425-823-1389
Mailing Address - Fax:425-820-3996
Practice Address - Street 1:10600 NE 68TH ST STE C
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7044
Practice Address - Country:US
Practice Address - Phone:425-823-1389
Practice Address - Fax:425-820-3996
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61441610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist