Provider Demographics
NPI:1164546016
Name:WATERFRONT SPORTS AND PHYSICAL THERAPY
Entity Type:Organization
Organization Name:WATERFRONT SPORTS AND PHYSICAL THERAPY
Other - Org Name:MOTUS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-801-7546
Mailing Address - Street 1:20109 AURORA AVE N STE 105
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3127
Mailing Address - Country:US
Mailing Address - Phone:206-801-7546
Mailing Address - Fax:206-801-7547
Practice Address - Street 1:20109 AURORA AVE N STE 105
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3127
Practice Address - Country:US
Practice Address - Phone:206-801-7546
Practice Address - Fax:206-801-7547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-18
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty