Provider Demographics
NPI:1558436923
Name:FACTORIA SPORTS AND SPINE PHYSICAL THERAPY P S
Entity Type:Organization
Organization Name:FACTORIA SPORTS AND SPINE PHYSICAL THERAPY P S
Other - Org Name:PEAK SPORTS & SPINE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARARAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:425-653-7100
Mailing Address - Street 1:14100 SE 36TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1657
Mailing Address - Country:US
Mailing Address - Phone:425-653-7100
Mailing Address - Fax:425-653-7109
Practice Address - Street 1:14100 SE 36TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1657
Practice Address - Country:US
Practice Address - Phone:425-653-7100
Practice Address - Fax:425-653-7109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB26232Medicare ID - Type Unspecified