Provider Demographics
NPI:1508874801
Name:NORTH HARBOR PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:NORTH HARBOR PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:BUCKHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:253-722-5511
Mailing Address - Street 1:11430 51ST AVE NW
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-7897
Mailing Address - Country:US
Mailing Address - Phone:253-858-8555
Mailing Address - Fax:253-858-8560
Practice Address - Street 1:11430 51ST AVE NW
Practice Address - Street 2:SUITE 101B
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-7897
Practice Address - Country:US
Practice Address - Phone:253-858-8555
Practice Address - Fax:253-858-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602512736174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7200132Medicaid
WAG8857432Medicare ID - Type UnspecifiedNHPT