Provider Demographics
NPI:1104369511
Name:MOUNTAIN2CITY PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:MOUNTAIN2CITY PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:SERWOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:206-601-6084
Mailing Address - Street 1:PO BOX 1570
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-4570
Mailing Address - Country:US
Mailing Address - Phone:206-601-6084
Mailing Address - Fax:
Practice Address - Street 1:100 2ND AVE S STE 160
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3551
Practice Address - Country:US
Practice Address - Phone:206-601-6084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty