Provider Demographics
NPI:1255870671
Name:TOTEM PHYSICAL THERAPY PS
Entity Type:Organization
Organization Name:TOTEM PHYSICAL THERAPY PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:253-759-1310
Mailing Address - Street 1:1802 S. UNION AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1950
Mailing Address - Country:US
Mailing Address - Phone:253-759-1310
Mailing Address - Fax:253-759-1330
Practice Address - Street 1:1802 S. UNION AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1950
Practice Address - Country:US
Practice Address - Phone:253-759-1310
Practice Address - Fax:253-759-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6719261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7130487Medicaid
WA7130487Medicaid
WA8857006Medicare PIN