Provider Demographics
NPI:1619018215
Name:MARINE VIEW PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:MARINE VIEW PHYSICAL THERAPY, INC
Other - Org Name:MARINE VIEW PHYSICAL THERAPY OR MVPT, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:SCANLON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:206-592-0568
Mailing Address - Street 1:22007 MARINE VIEW DR S STE 203
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6259
Mailing Address - Country:US
Mailing Address - Phone:206-592-0568
Mailing Address - Fax:206-592-0583
Practice Address - Street 1:22007 MARINE VIEW DR S STE 203
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6259
Practice Address - Country:US
Practice Address - Phone:206-592-0568
Practice Address - Fax:206-592-0583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602252479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty