Provider Demographics
NPI:1083239073
Name:FOUNDATIONS THERAFITNESS AND PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:FOUNDATIONS THERAFITNESS AND PHYSICAL THERAPY LLC
Other - Org Name:FOUNDATIONS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST, CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACEE
Authorized Official - Middle Name:JEAN MARTIN
Authorized Official - Last Name:KARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-584-4556
Mailing Address - Street 1:6028 TIGER TAIL DR SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-2141
Mailing Address - Country:US
Mailing Address - Phone:360-584-4556
Mailing Address - Fax:
Practice Address - Street 1:1802 BLACK LAKE BLVD SW STE 103
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-5634
Practice Address - Country:US
Practice Address - Phone:360-584-4556
Practice Address - Fax:360-251-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy