Provider Demographics
NPI:1871654475
Name:MANUAL THERAPY INTERNATIONAL PROFESSIONAL SERVICES PLLC
Entity Type:Organization
Organization Name:MANUAL THERAPY INTERNATIONAL PROFESSIONAL SERVICES PLLC
Other - Org Name:MTI PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:K
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:425-746-2475
Mailing Address - Street 1:1560 140TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-4571
Mailing Address - Country:US
Mailing Address - Phone:425-746-2475
Mailing Address - Fax:425-746-2471
Practice Address - Street 1:1560 140TH AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-4571
Practice Address - Country:US
Practice Address - Phone:425-746-2475
Practice Address - Fax:425-746-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601855652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB09888Medicare PIN