Provider Demographics
NPI:1295039352
Name:GREEN GRASS PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:GREEN GRASS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOUNDUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS, MTC
Authorized Official - Phone:206-910-9590
Mailing Address - Street 1:2319 N 45TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6982
Mailing Address - Country:US
Mailing Address - Phone:206-910-9590
Mailing Address - Fax:
Practice Address - Street 1:2319 N 45TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6982
Practice Address - Country:US
Practice Address - Phone:206-910-9590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010361261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy