Provider Demographics
NPI:1598889503
Name:SYMMETRY PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:SYMMETRY PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:PAINE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:425-451-0649
Mailing Address - Street 1:1940 116TH AVE NE
Mailing Address - Street 2:100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3011
Mailing Address - Country:US
Mailing Address - Phone:425-451-0649
Mailing Address - Fax:425-451-0655
Practice Address - Street 1:1940 116TH AVE NE
Practice Address - Street 2:100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3011
Practice Address - Country:US
Practice Address - Phone:425-451-0649
Practice Address - Fax:425-451-0655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2013-03-26
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
WA5781SYOtherBLUE CROSS- BLUE SHIELD
WA0194962OtherLABOR AND INDUSTRIES
WA7105026Medicaid
WA0194962OtherLABOR AND INDUSTRIES