Provider Demographics
NPI:1639219868
Name:BAINBRIDGE ISLAND PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:BAINBRIDGE ISLAND PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINZELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-855-8880
Mailing Address - Street 1:563 MADISON AVE N
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1768
Mailing Address - Country:US
Mailing Address - Phone:206-855-8455
Mailing Address - Fax:206-855-8465
Practice Address - Street 1:563 MADISON AVE N
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1768
Practice Address - Country:US
Practice Address - Phone:206-855-8455
Practice Address - Fax:206-855-8465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008747225100000X, 2251H1200X, 2251S0007X, 2251X0800X
WAPT00007979225100000X, 2251C2600X, 2251E1200X, 2251G0304X, 2251S0007X, 2251X0800X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonaryGroup - Multi-Specialty
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomicsGroup - Multi-Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0184534OtherDEPT OF LABOR & INDUSTRY
WA7132533Medicaid
WA7375455OtherAETNA
WA=========OtherAETNA
WA=========OtherREGENCE
WA=========OtherUNIFORM MEDICAL
WA=========OtherKPS HEALTH PLANS
WA=========OtherFIRST CHOICE
WA=========OtherCIGNA
WA7132533Medicaid
WA=========OtherAETNA