Provider Demographics
NPI:1558576256
Name:OUTPATIENT PHYSICAL THERAPY & SPORTS REHABILITATION INC PC
Entity Type:Organization
Organization Name:OUTPATIENT PHYSICAL THERAPY & SPORTS REHABILITATION INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZACH
Authorized Official - Middle Name:
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-413-4427
Mailing Address - Street 1:26837 MAPLE VALLEY BLACK DIAMOND RD SE
Mailing Address - Street 2:STE #201
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-9917
Mailing Address - Country:US
Mailing Address - Phone:425-413-4427
Mailing Address - Fax:425-413-4429
Practice Address - Street 1:26837 MAPLE VALLEY BLACK DIAMOND RD SE
Practice Address - Street 2:STE #201
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-9917
Practice Address - Country:US
Practice Address - Phone:425-413-4427
Practice Address - Fax:425-413-4429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB22152Medicare PIN