Provider Demographics
NPI:1093956450
Name:UPTOWN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:UPTOWN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:AERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS, COMT
Authorized Official - Phone:360-385-1035
Mailing Address - Street 1:1215 LAWRENCE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-6559
Mailing Address - Country:US
Mailing Address - Phone:360-385-1035
Mailing Address - Fax:360-385-4395
Practice Address - Street 1:1215 LAWRENCE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6559
Practice Address - Country:US
Practice Address - Phone:360-385-1035
Practice Address - Fax:360-385-4395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7105760Medicaid
WA7684202Medicaid
WA0244023OtherLABOR AND INDUSTRY
WA7684202Medicaid
WA0244023OtherLABOR AND INDUSTRY