Provider Demographics
NPI:1467755397
Name:SOUTHWEST SEATTLE PHYSICAL THERAPY & SPORTS REHABILITATION INC.
Entity type:Organization
Organization Name:SOUTHWEST SEATTLE PHYSICAL THERAPY & SPORTS REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MCPHEE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:206-248-3414
Mailing Address - Street 1:15410 AMBAUM BLVD SW
Mailing Address - Street 2:SUITE #103
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2402
Mailing Address - Country:US
Mailing Address - Phone:206-248-3414
Mailing Address - Fax:206-244-6755
Practice Address - Street 1:15410 AMBAUM BLVD SW
Practice Address - Street 2:SUITE #103
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2402
Practice Address - Country:US
Practice Address - Phone:206-248-3414
Practice Address - Fax:206-244-6755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7042575Medicaid
WA7042575Medicaid