Provider Demographics
NPI:1023389764
Name:YELM PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:YELM PHYSICAL THERAPY, PLLC
Other - Org Name:YELM PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIPE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT SCS
Authorized Official - Phone:360-951-0754
Mailing Address - Street 1:514 W YELM AVE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-7679
Mailing Address - Country:US
Mailing Address - Phone:360-458-2444
Mailing Address - Fax:360-458-2747
Practice Address - Street 1:514 W YELM AVE
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7679
Practice Address - Country:US
Practice Address - Phone:360-458-2444
Practice Address - Fax:360-458-2747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty