Provider Demographics
NPI:1275710360
Name:MARITIME PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MARITIME PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:HABERSTRO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:253-272-2021
Mailing Address - Street 1:246 ST HELENS AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-2522
Mailing Address - Country:US
Mailing Address - Phone:253-272-2021
Mailing Address - Fax:253-272-2360
Practice Address - Street 1:246 ST HELENS AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-2522
Practice Address - Country:US
Practice Address - Phone:253-272-2021
Practice Address - Fax:253-272-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT3697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty