Provider Demographics
NPI:1215032701
Name:ALLIANCE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ALLIANCE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WITTROCK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:253-838-2464
Mailing Address - Street 1:34507 PACIFIC HWY S STE 6
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6879
Mailing Address - Country:US
Mailing Address - Phone:253-838-2464
Mailing Address - Fax:253-838-4991
Practice Address - Street 1:34507 PACIFIC HWY S STE 6
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6879
Practice Address - Country:US
Practice Address - Phone:253-838-2464
Practice Address - Fax:253-838-4991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7099658Medicaid
WAGAB12173Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER