Provider Demographics
NPI:1821272469
Name:NORTHWEST REHABILITATION ASSOCIATES, INC., PS
Entity Type:Organization
Organization Name:NORTHWEST REHABILITATION ASSOCIATES, INC., PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:BRZUSEK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:425-453-1000
Mailing Address - Street 1:1600 116TH AVE NE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3014
Mailing Address - Country:US
Mailing Address - Phone:425-453-1000
Mailing Address - Fax:425-454-3590
Practice Address - Street 1:1600 116TH AVE NE
Practice Address - Street 2:SUITE 202
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3014
Practice Address - Country:US
Practice Address - Phone:425-453-1000
Practice Address - Fax:425-454-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP000007272081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty