Provider Demographics
NPI:1669685913
Name:VASHON PHYSICAL THERAPY
Entity Type:Organization
Organization Name:VASHON PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLEPROPRIETER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:NELL
Authorized Official - Last Name:KLEYN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:206-463-3441
Mailing Address - Street 1:PO BOX 2189
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-2189
Mailing Address - Country:US
Mailing Address - Phone:206-463-3441
Mailing Address - Fax:206-463-3089
Practice Address - Street 1:17429 VASHON HWY. SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070
Practice Address - Country:US
Practice Address - Phone:206-463-3441
Practice Address - Fax:206-463-3089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00001022174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8340291Medicaid
WADF2398OtherRAILROAD MEDICARE
WAGAB33726Medicare PIN