Provider Demographics
NPI:1053322875
Name:MARRAN PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MARRAN PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RANK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:425-284-1767
Mailing Address - Street 1:8301 161ST AVE NE
Mailing Address - Street 2:SUITE #103
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3858
Mailing Address - Country:US
Mailing Address - Phone:425-284-1767
Mailing Address - Fax:425-284-3302
Practice Address - Street 1:8301 161ST AVE NE
Practice Address - Street 2:SUITE #103
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3858
Practice Address - Country:US
Practice Address - Phone:425-284-1767
Practice Address - Fax:425-284-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602049960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB19703Medicare PIN