Provider Demographics
NPI:1326111477
Name:AURORA VILLAGE PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:AURORA VILLAGE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:CLUTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHYISCAL THERAPIST
Authorized Official - Phone:206-542-1986
Mailing Address - Street 1:1207 N 200TH ST
Mailing Address - Street 2:103
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3213
Mailing Address - Country:US
Mailing Address - Phone:206-542-1986
Mailing Address - Fax:206-542-1144
Practice Address - Street 1:1207 N 200TH ST
Practice Address - Street 2:103
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3213
Practice Address - Country:US
Practice Address - Phone:206-542-1986
Practice Address - Fax:206-542-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0148810OtherLABOR AND INDUSTRIES
WA242772700OtherACS
WA7061617OtherSOCIAL & HEALTH SERVICES
WA7061617OtherSOCIAL & HEALTH SERVICES