Provider Demographics
NPI:1326790502
Name:DIRECT ACCESS THERAPY PLLC
Entity Type:Organization
Organization Name:DIRECT ACCESS THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:206-818-4739
Mailing Address - Street 1:444 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-9514
Mailing Address - Country:US
Mailing Address - Phone:206-818-4739
Mailing Address - Fax:
Practice Address - Street 1:444 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-9514
Practice Address - Country:US
Practice Address - Phone:206-818-4739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty