Provider Demographics
NPI:1275766172
Name:STRETCH LLC
Entity Type:Organization
Organization Name:STRETCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:WOLFGANG
Authorized Official - Middle Name:E
Authorized Official - Last Name:BROLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPT,LMP,RC
Authorized Official - Phone:206-624-7602
Mailing Address - Street 1:201 YALE AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-5430
Mailing Address - Country:US
Mailing Address - Phone:206-624-7602
Mailing Address - Fax:206-624-7606
Practice Address - Street 1:201 YALE AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5430
Practice Address - Country:US
Practice Address - Phone:206-624-7602
Practice Address - Fax:206-624-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602622922261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0235644OtherWASHINGTON STATE DEPARTMENT OF LABOUR AND INDUSTRIES