Provider Demographics
NPI:1497936892
Name:SQUAK MOUNTAIN PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:SQUAK MOUNTAIN PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:HOLLIS
Authorized Official - Last Name:LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:425-392-8335
Mailing Address - Street 1:5825 221ST PL SE
Mailing Address - Street 2:STE 206
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8927
Mailing Address - Country:US
Mailing Address - Phone:425-392-8335
Mailing Address - Fax:425-392-8338
Practice Address - Street 1:5825 221ST PL SE
Practice Address - Street 2:STE 206
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8927
Practice Address - Country:US
Practice Address - Phone:425-392-8335
Practice Address - Fax:425-392-8338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy