Provider Demographics
NPI:1548590227
Name:TURNING LEAF PHYSICAL THERAPY
Entity Type:Organization
Organization Name:TURNING LEAF PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:JAN
Authorized Official - Last Name:LEAF
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:253-514-7701
Mailing Address - Street 1:9107 73RD AVENUE CT NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-6727
Mailing Address - Country:US
Mailing Address - Phone:253-514-7701
Mailing Address - Fax:253-853-3987
Practice Address - Street 1:9107 73RD AVENUE CT NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-6727
Practice Address - Country:US
Practice Address - Phone:253-514-7701
Practice Address - Fax:253-853-3987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-02
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 00008055261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8341778OtherDSHS
WA1053384727OtherOWCP
WA616881800OtherFEDERAL L&I