Provider Demographics
NPI:1568669638
Name:REX PHYSICAL THERAPY SERVICES
Entity Type:Organization
Organization Name:REX PHYSICAL THERAPY SERVICES
Other - Org Name:REX PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:J
Authorized Official - Last Name:REX
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:206-522-7141
Mailing Address - Street 1:9501 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2108
Mailing Address - Country:US
Mailing Address - Phone:206-522-7141
Mailing Address - Fax:206-522-7234
Practice Address - Street 1:9501 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2108
Practice Address - Country:US
Practice Address - Phone:206-522-7141
Practice Address - Fax:206-522-7234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-30
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7060346Medicaid
AB20388Medicare ID - Type Unspecified