Provider Demographics
NPI:1497154504
Name:INNOVA PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:INNOVA PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-658-4977
Mailing Address - Street 1:8630 164TH AVE NE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3606
Mailing Address - Country:US
Mailing Address - Phone:425-658-4980
Mailing Address - Fax:
Practice Address - Street 1:8630 164TH AVE NE
Practice Address - Street 2:SUITE 203
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3606
Practice Address - Country:US
Practice Address - Phone:425-658-4980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty