Provider Demographics
NPI:1619152469
Name:AUBURN SPORTS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:AUBURN SPORTS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER PT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:253-736-2340
Mailing Address - Street 1:801 AUBURN WAY N
Mailing Address - Street 2:SUITE E
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4164
Mailing Address - Country:US
Mailing Address - Phone:253-736-2340
Mailing Address - Fax:253-736-2343
Practice Address - Street 1:801 AUBURN WAY N
Practice Address - Street 2:SUITE E
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4164
Practice Address - Country:US
Practice Address - Phone:253-736-2340
Practice Address - Fax:253-736-2343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty