Provider Demographics
NPI:1619060308
Name:PUYALLUP VALLEY PHYSICAL THERAPY, INC. P. S.
Entity Type:Organization
Organization Name:PUYALLUP VALLEY PHYSICAL THERAPY, INC. P. S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:253-848-2309
Mailing Address - Street 1:2520 7TH ST. SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-1105
Mailing Address - Country:US
Mailing Address - Phone:253-848-2309
Mailing Address - Fax:253-848-8407
Practice Address - Street 1:2520 7TH ST. SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-1105
Practice Address - Country:US
Practice Address - Phone:253-848-2309
Practice Address - Fax:253-848-8407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7206204Medicaid
WA7206204Medicaid