Provider Demographics
NPI:1497927271
Name:EDMONDS PHYSICAL THERAPY & SPORTS REHAB
Entity Type:Organization
Organization Name:EDMONDS PHYSICAL THERAPY & SPORTS REHAB
Other - Org Name:EDMONDS PHYSICAL THERAPY & SPORTS REHABILITATION, P.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CATES
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:425-774-3226
Mailing Address - Street 1:7315 212TH ST SW
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7610
Mailing Address - Country:US
Mailing Address - Phone:425-774-3226
Mailing Address - Fax:425-670-1406
Practice Address - Street 1:7315 212TH ST SW
Practice Address - Street 2:SUITE 104
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7610
Practice Address - Country:US
Practice Address - Phone:425-774-3226
Practice Address - Fax:425-670-1406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002026225100000X
WAPT00002027225100000X
WAPT60056174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty