Provider Demographics
NPI:1598897001
Name:COPPERSMITH ORTH & SPORTS PT
Entity Type:Organization
Organization Name:COPPERSMITH ORTH & SPORTS PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:S
Authorized Official - Last Name:COPPERSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:206-524-6702
Mailing Address - Street 1:5025 25TH AVE NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4151
Mailing Address - Country:US
Mailing Address - Phone:206-524-6702
Mailing Address - Fax:206-524-6703
Practice Address - Street 1:5025 25TH AVE NE
Practice Address - Street 2:SUITE 201
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4151
Practice Address - Country:US
Practice Address - Phone:206-524-6702
Practice Address - Fax:206-524-6703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002380261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911891680OtherPREMERA BLUE CROSS
WA911891680OtherUNIFORM MEDICAL
WA911891680OtherPHCS
WA911891680OtherAETNA
WA911891680OtherUNITED HEALTHCARE
WA911891680OtherFIRST CHOICE
WA911891680OtherUNIFORM MEDICAL
WA911891680OtherUNIFORM MEDICAL
WADA5883Medicare ID - Type UnspecifiedRAILROAD MEDICARE