Provider Demographics
NPI:1578948923
Name:ABC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ABC PHYSICAL THERAPY
Other - Org Name:ALTERNATIVE BACK CARE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:253-564-2220
Mailing Address - Street 1:3502 S 12TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2279
Mailing Address - Country:US
Mailing Address - Phone:253-564-2220
Mailing Address - Fax:253-564-2221
Practice Address - Street 1:425 SW 41ST ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4926
Practice Address - Country:US
Practice Address - Phone:253-564-2220
Practice Address - Fax:253-564-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006703261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy