Provider Demographics
NPI:1972920502
Name:NORTHWEST PHYSICAL MEDICINE PS
Entity type:Organization
Organization Name:NORTHWEST PHYSICAL MEDICINE PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMON
Authorized Official - Middle Name:
Authorized Official - Last Name:KOONER
Authorized Official - Suffix:
Authorized Official - Credentials:D,C,
Authorized Official - Phone:425-455-2225
Mailing Address - Street 1:10655 NE 4TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5022
Mailing Address - Country:US
Mailing Address - Phone:425-455-2225
Mailing Address - Fax:425-454-7767
Practice Address - Street 1:10655 NE 4TH ST STE 101
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5022
Practice Address - Country:US
Practice Address - Phone:425-455-2225
Practice Address - Fax:425-454-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60322491174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty