Provider Demographics
NPI:1316124977
Name:SEDRO WOOLLEY PHYSICAL THERAPY, INC., PS
Entity type:Organization
Organization Name:SEDRO WOOLLEY PHYSICAL THERAPY, INC., PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:DAWES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-856-4200
Mailing Address - Street 1:638 SUNSET PARK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-1546
Mailing Address - Country:US
Mailing Address - Phone:360-856-4200
Mailing Address - Fax:360-856-4220
Practice Address - Street 1:638 SUNSET PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1546
Practice Address - Country:US
Practice Address - Phone:360-856-4200
Practice Address - Fax:360-856-4220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT0008276261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0227042OtherLABOR & INDUSTRIES
WA8436180Medicaid