Provider Demographics
NPI:1710388632
Name:QUANTUM LEAP PHYSICAL THERAPY
Entity Type:Organization
Organization Name:QUANTUM LEAP PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-990-6627
Mailing Address - Street 1:10432 NE BRACKENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1123
Mailing Address - Country:US
Mailing Address - Phone:206-780-5467
Mailing Address - Fax:866-590-7449
Practice Address - Street 1:225 NW LINDVIG WAY STE 6
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9090
Practice Address - Country:US
Practice Address - Phone:360-990-6627
Practice Address - Fax:866-590-7449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00009235261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy