Provider Demographics
NPI:1093876898
Name:HIGHLINE PHYSICAL THERAPY GROUP
Entity Type:Organization
Organization Name:HIGHLINE PHYSICAL THERAPY GROUP
Other - Org Name:HIGHLINE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOPET
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:206-242-5186
Mailing Address - Street 1:181 S 333RD ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7363
Mailing Address - Country:US
Mailing Address - Phone:253-874-2998
Mailing Address - Fax:253-874-3307
Practice Address - Street 1:16259 SYLVESTER RD SW
Practice Address - Street 2:SUITE 102
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3049
Practice Address - Country:US
Practice Address - Phone:206-242-5186
Practice Address - Fax:206-241-8467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7081748Medicaid
WA7033368Medicaid
WA192343300OtherUSDL
WA54497OtherINDUSTRIAL INJURY INS
WA7683030Medicaid
WA7030562Medicaid
WA7044852Medicaid
WA8581304OtherAETNA GROUP NUMBER
WA7105653Medicaid
WAHI2807OtherREGENCE GROUP NUMBER
WA54497OtherINDUSTRIAL INJURY INS