Provider Demographics
NPI:1508086331
Name:MTI PHYSICAL THERAPY TACOMA
Entity Type:Organization
Organization Name:MTI PHYSICAL THERAPY TACOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR PT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:253-471-7200
Mailing Address - Street 1:7800 PACIFIC AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-7050
Mailing Address - Country:US
Mailing Address - Phone:253-471-7200
Mailing Address - Fax:
Practice Address - Street 1:7800 PACIFIC AVE STE 8
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7050
Practice Address - Country:US
Practice Address - Phone:253-471-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2022-07-21
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