Provider Demographics
NPI:1619120763
Name:REFLEX PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:REFLEX PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:360-357-1311
Mailing Address - Street 1:1107 EASTSIDE ST SE STE B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2442
Mailing Address - Country:US
Mailing Address - Phone:360-705-0254
Mailing Address - Fax:360-705-0268
Practice Address - Street 1:1107 EASTSIDE ST SE STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2442
Practice Address - Country:US
Practice Address - Phone:360-705-0254
Practice Address - Fax:360-705-0268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-01
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 00010439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty