Provider Demographics
NPI:1851661573
Name:ADVANCED THERAPY & SPORTS REHABILITATION,INC.
Entity type:Organization
Organization Name:ADVANCED THERAPY & SPORTS REHABILITATION,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOBER
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:425-746-0752
Mailing Address - Street 1:2310 130TH AVE NE # B103
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1799
Mailing Address - Country:US
Mailing Address - Phone:425-890-3989
Mailing Address - Fax:425-746-1587
Practice Address - Street 1:12811 SE 38TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1326
Practice Address - Country:US
Practice Address - Phone:425-746-0752
Practice Address - Fax:425-746-1587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1497896005OtherTYPE-1 NPI
WA1851661573OtherNPI GROUP #
WAGAB15668Medicare PIN