Provider Demographics
NPI:1073086641
Name:PNW PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:PNW PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNDEE
Authorized Official - Middle Name:H
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-458-7686
Mailing Address - Street 1:10821 19TH AVE SE STE 102
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-5103
Mailing Address - Country:US
Mailing Address - Phone:425-225-5865
Mailing Address - Fax:425-948-6643
Practice Address - Street 1:10821 19TH AVE SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-5103
Practice Address - Country:US
Practice Address - Phone:509-458-7686
Practice Address - Fax:509-808-2164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA58715OtherCITY OF EVERETT