Provider Demographics
NPI:1174042493
Name:RECLAIM YOUR MAGICK
Entity Type:Organization
Organization Name:RECLAIM YOUR MAGICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FARROW
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:206-250-9134
Mailing Address - Street 1:2366 EASTLAKE AVE E STE 237
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-6500
Mailing Address - Country:US
Mailing Address - Phone:206-250-9134
Mailing Address - Fax:
Practice Address - Street 1:2366 EASTLAKE AVE E STE 237
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-6500
Practice Address - Country:US
Practice Address - Phone:206-250-9134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty