Provider Demographics
NPI:1225582844
Name:NORTHWEST CENTER FOR SPORTS MEDICINE & PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:NORTHWEST CENTER FOR SPORTS MEDICINE & PHYSICAL THERAPY, INC.
Other - Org Name:NORTHWEST SPORTS PHYSICAL THERAPY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-851-7472
Mailing Address - Street 1:4411 POINT FOSDICK DR NW STE 101
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1703
Mailing Address - Country:US
Mailing Address - Phone:253-851-7472
Mailing Address - Fax:253-851-7473
Practice Address - Street 1:1550 S UNION AVE STE 130
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1946
Practice Address - Country:US
Practice Address - Phone:253-552-2525
Practice Address - Fax:253-552-2526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60665371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty