Provider Demographics
NPI:1588098305
Name:PACIFIC PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:PACIFIC PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-329-7052
Mailing Address - Street 1:1950 POTTERY AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2501
Mailing Address - Country:US
Mailing Address - Phone:360-329-7052
Mailing Address - Fax:360-329-7053
Practice Address - Street 1:1950 POTTERY AVE STE 110
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2501
Practice Address - Country:US
Practice Address - Phone:360-329-7052
Practice Address - Fax:360-329-7053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60392890261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy