Provider Demographics
NPI:1528147303
Name:WASHINGTON PHYSICAL THERAPY AND REHABILITATION LLC
Entity type:Organization
Organization Name:WASHINGTON PHYSICAL THERAPY AND REHABILITATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:425-820-2110
Mailing Address - Street 1:6725 116TH AVE NE STE 130
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-8455
Mailing Address - Country:US
Mailing Address - Phone:425-820-2110
Mailing Address - Fax:425-820-2111
Practice Address - Street 1:6725 116TH AVE NE STE 130
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-8455
Practice Address - Country:US
Practice Address - Phone:425-820-2110
Practice Address - Fax:425-820-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7096613Medicaid
WA7096613Medicaid