Provider Demographics
NPI:1467632745
Name:OLYMPIA PHYSICAL THERAPY & INDUSTRIAL REHABILITATION, INC.
Entity Type:Organization
Organization Name:OLYMPIA PHYSICAL THERAPY & INDUSTRIAL REHABILITATION, INC.
Other - Org Name:DBA HAWK'S PRAIRIE PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:MPT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:360-352-5077
Mailing Address - Street 1:2755 MOTTMAN RD SW
Mailing Address - Street 2:OLYMPIA PHYSICAL THERAPY & REHABILITATION, INC.
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-5684
Mailing Address - Country:US
Mailing Address - Phone:360-352-5077
Mailing Address - Fax:360-352-5022
Practice Address - Street 1:8750 TALON LN NE
Practice Address - Street 2:HAWKS PRAIRIE SUITE C
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-6642
Practice Address - Country:US
Practice Address - Phone:360-456-1072
Practice Address - Fax:360-459-9954
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLYMPIA PHYSICAL THERAPY AND INDUSTRIAL REHABILITATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-05
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACK7840OtherRAILROAD MEDICARE
WA017966 0001OtherPACIFICARE
WA7115074Medicaid
WA0166743OtherLABOR & INDUSTRIES
WAGAB35036Medicare PIN
WACK7840OtherRAILROAD MEDICARE