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
State | License ID | Taxonomies |
---|---|---|
WA | PT00008747 | 225100000X, 2251H1200X, 2251S0007X, 2251X0800X |
WA | PT00007979 | 225100000X, 2251C2600X, 2251E1200X, 2251G0304X, 2251S0007X, 2251X0800X |
261QP2000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 2251C2600X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Cardiopulmonary | Group - Multi-Specialty |
No | 2251E1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Ergonomics | Group - Multi-Specialty |
No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics | Group - Multi-Specialty |
No | 2251H1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand | Group - Multi-Specialty |
No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | Group - Multi-Specialty |
No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Multi-Specialty |
No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WA | 0184534 | Other | DEPT OF LABOR & INDUSTRY |
WA | 7132533 | Medicaid | |
WA | 7375455 | Other | AETNA |
WA | ========= | Other | AETNA |
WA | ========= | Other | REGENCE |
WA | ========= | Other | UNIFORM MEDICAL |
WA | ========= | Other | KPS HEALTH PLANS |
WA | ========= | Other | FIRST CHOICE |
WA | ========= | Other | CIGNA |
WA | 7132533 | Medicaid | |
WA | ========= | Other | AETNA |