Provider Demographics
NPI:1225116916
Name:PINNACLE THERAPY GROUP
Entity Type:Organization
Organization Name:PINNACLE THERAPY GROUP
Other - Org Name:PINNACLE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:K
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:425-433-0123
Mailing Address - Street 1:24060 SE KENT KANGLEY RD
Mailing Address - Street 2:D-100
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-6801
Mailing Address - Country:US
Mailing Address - Phone:425-433-0123
Mailing Address - Fax:425-433-0733
Practice Address - Street 1:24060 SE KENT KANGLEY RD
Practice Address - Street 2:D-100
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-6801
Practice Address - Country:US
Practice Address - Phone:425-433-0123
Practice Address - Fax:425-433-0733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8807165Medicare PIN